Provider Demographics
NPI:1578569745
Name:BOLSTAD, KARL E (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:E
Last Name:BOLSTAD
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-1332
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:510 EMERGENCY DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6804
Practice Address - Country:US
Practice Address - Phone:336-249-2978
Practice Address - Fax:336-249-6748
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23471207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8916482Medicaid
200027502OtherRAILROAD MEDICARE
NC8916482Medicaid
NCC82869Medicare UPIN