Provider Demographics
NPI:1568557163
Name:BOLISAJIAN, SARKIS (MD)
Entity Type:Individual
Prefix:
First Name:SARKIS
Middle Name:
Last Name:BOLISAJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 TENTH STREET
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2343
Mailing Address - Country:US
Mailing Address - Phone:507-372-2921
Mailing Address - Fax:507-372-1815
Practice Address - Street 1:508 TENTH STREET
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2343
Practice Address - Country:US
Practice Address - Phone:507-372-2921
Practice Address - Fax:507-372-1815
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110185119OtherRR MEDICARE
IA0517417Medicaid
MN02S35BOOtherBCBS MN
MN128044OtherUCARE
MN580823500Medicaid