Provider Demographics
NPI:1598941148
Name:BOLUKH, OLEH (MD)
Entity Type:Individual
Prefix:DR
First Name:OLEH
Middle Name:
Last Name:BOLUKH
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 1:2539 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-5648
Mailing Address - Country:US
Mailing Address - Phone:586-558-5075
Mailing Address - Fax:586-558-5078
Practice Address - Street 1:2539 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5648
Practice Address - Country:US
Practice Address - Phone:586-558-5075
Practice Address - Fax:586-558-5078
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine