Provider Demographics
NPI:1740467810
Name:BOLTON, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BOLTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-335-9449
Mailing Address - Fax:248-858-3933
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-335-9449
Practice Address - Fax:248-858-3933
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301038308208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301038308OtherSTATE LICENSE
MI0206308521OtherBCBSMI
MI0206308521OtherBCBSMI
MIA73405Medicare UPIN
MI4301038308OtherSTATE LICENSE