Provider Demographics
NPI:1376333435
Name:BOLUS, MICHAEL (MD, PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BOLUS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 21ST AVE S
Mailing Address - Street 2:B1124 MCN
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-2521
Mailing Address - Country:US
Mailing Address - Phone:615-322-7484
Mailing Address - Fax:615-343-8806
Practice Address - Street 1:1161 21ST AVE S
Practice Address - Street 2:B1124 MCN
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2521
Practice Address - Country:US
Practice Address - Phone:205-213-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program