Provider Demographics
NPI:1881171023
Name:TOLBERT, BILL
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:
Last Name:TOLBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 ADLER CIR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-6413
Mailing Address - Country:US
Mailing Address - Phone:219-762-3465
Mailing Address - Fax:
Practice Address - Street 1:1605 ADLER CIR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-6413
Practice Address - Country:US
Practice Address - Phone:219-762-3465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator