Provider Demographics
NPI:1932788841
Name:BOLZMAN, ELIZABETH ANNE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:BOLZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:PAULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 W OAK ST
Mailing Address - Street 2:SUITE 200, MC 632
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2155
Mailing Address - Country:US
Mailing Address - Phone:616-754-4685
Mailing Address - Fax:616-754-9883
Practice Address - Street 1:1202 W OAK ST
Practice Address - Street 2:SUITE 200, MC 632
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2155
Practice Address - Country:US
Practice Address - Phone:616-754-4685
Practice Address - Fax:616-754-9883
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4351048040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program