Provider Demographics
NPI:1003019894
Name:BOLING MEDICAL LLC
Entity Type:Organization
Organization Name:BOLING MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:KAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-226-1800
Mailing Address - Street 1:899 S WEBER RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-5488
Mailing Address - Country:US
Mailing Address - Phone:630-226-1800
Mailing Address - Fax:630-226-4226
Practice Address - Street 1:899 S WEBER RD
Practice Address - Street 2:SUITE G
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-5488
Practice Address - Country:US
Practice Address - Phone:630-226-1800
Practice Address - Fax:630-226-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty