Provider Demographics
NPI:1952577652
Name:BOLIS, NAHED KALAM (DPM)
Entity Type:Individual
Prefix:
First Name:NAHED
Middle Name:KALAM
Last Name:BOLIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:NAHED
Other - Middle Name:KALAM
Other - Last Name:ABDELNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5141 DEER PARK DR
Mailing Address - Street 2:STE 1C
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-7013
Mailing Address - Country:US
Mailing Address - Phone:727-847-2406
Mailing Address - Fax:727-841-0567
Practice Address - Street 1:5463 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1110
Practice Address - Country:US
Practice Address - Phone:352-596-3338
Practice Address - Fax:352-597-3986
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3351213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65069OtherBCBS-FL
FLP00807405OtherRR MEDICARE
FLP00955965OtherRR MCR ATTACHED TO GRP# DR6927
FL000745200Medicaid
FLP00955965OtherRR MCR ATTACHED TO GRP# DR6927
FLBI000ZMedicare PIN