Provider Demographics
NPI:1275827701
Name:BOLGER, DAVE (DO)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:BOLGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4901 W 79TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459-1554
Mailing Address - Country:US
Mailing Address - Phone:708-499-1545
Mailing Address - Fax:708-499-4862
Practice Address - Street 1:4901 W 79TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1554
Practice Address - Country:US
Practice Address - Phone:708-499-1545
Practice Address - Fax:708-499-4862
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2014-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036135786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine