Provider Demographics
NPI:1205896941
Name:BOLISAY, MARIA RITA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA RITA
Middle Name:
Last Name:BOLISAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1116 MILLIS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-2242
Mailing Address - Country:US
Mailing Address - Phone:812-897-7383
Mailing Address - Fax:812-897-7236
Practice Address - Street 1:1116 MILLIS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-2242
Practice Address - Country:US
Practice Address - Phone:812-897-7383
Practice Address - Fax:812-897-7236
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01047204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000254914OtherBLUE CROSS
IN200138620Medicaid
IN194940BMedicare PIN
IN200138620Medicaid