Provider Demographics
NPI:1518943901
Name:BOLT, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:BOLT
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1902 S US HIGHWAY 59 BLDG E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-4948
Mailing Address - Country:US
Mailing Address - Phone:620-820-5840
Mailing Address - Fax:620-820-5841
Practice Address - Street 1:1902 S US HIGHWAY 59 BLDG E
Practice Address - Street 2:SUITE 300
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-4948
Practice Address - Country:US
Practice Address - Phone:620-820-5840
Practice Address - Fax:620-820-5841
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0417184208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200362160 AMedicaid
KS105220Medicare PIN
B69290Medicare UPIN
KS200362160 AMedicaid