Provider Demographics
NPI:1245799469
Name:BOLAR, ZIPPORAH K SR (MD)
Entity Type:Individual
Prefix:
First Name:ZIPPORAH
Middle Name:K
Last Name:BOLAR
Suffix:SR
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ZIPPORAH
Other - Middle Name:K
Other - Last Name:BOLAR
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MD, LLPC
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-0181
Mailing Address - Country:US
Mailing Address - Phone:313-624-6043
Mailing Address - Fax:
Practice Address - Street 1:2900 CONNER ST BLDG A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2407
Practice Address - Country:US
Practice Address - Phone:313-308-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014024101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional