Provider Demographics
NPI:1477667731
Name:BOLLMAN, KAREN M (DO)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:BOLLMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1288 W GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9374
Mailing Address - Country:US
Mailing Address - Phone:517-655-7300
Mailing Address - Fax:517-655-7333
Practice Address - Street 1:1288 W GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-9374
Practice Address - Country:US
Practice Address - Phone:517-655-7300
Practice Address - Fax:517-655-7333
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4756773Medicaid
MI0100352OtherPHP
MI5330007OtherBLUE CARE NETWORK
MIP19420002Medicare ID - Type Unspecified
MIF99451Medicare UPIN