Provider Demographics
NPI:1558362871
Name:BOLDT, HERBERT CULVER (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:CULVER
Last Name:BOLDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H
Other - Middle Name:CULVER
Other - Last Name:BOLDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-353-6112
Mailing Address - Fax:319-356-0363
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-6112
Practice Address - Fax:319-356-0363
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26580207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0260117Medicaid
IA10167OtherWELLMARK BC/BS
A03636Medicare UPIN
IA0260117Medicaid