Provider Demographics
NPI:1225629678
Name:MICHAEL T. BOLER, M.D.
Entity Type:Organization
Organization Name:MICHAEL T. BOLER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLER
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-453-5331
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38935-0550
Mailing Address - Country:US
Mailing Address - Phone:662-453-5331
Mailing Address - Fax:662-453-5332
Practice Address - Street 1:201 WALTHALL ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4428
Practice Address - Country:US
Practice Address - Phone:662-453-5331
Practice Address - Fax:662-453-5332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL T. BOLER, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821071267OtherNPI