Provider Demographics
NPI:1952606147
Name:BOLSEN HEALTH CENTER
Entity Type:Organization
Organization Name:BOLSEN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ATTEH
Authorized Official - Last Name:OKAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-763-8334
Mailing Address - Street 1:6429 .W. NORTH AVENUE , SUITE 106
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302
Mailing Address - Country:US
Mailing Address - Phone:708-763-8334
Mailing Address - Fax:630-833-5742
Practice Address - Street 1:150 E SCHILLER ST APT 506
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2852
Practice Address - Country:US
Practice Address - Phone:630-833-5732
Practice Address - Fax:630-833-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILD046435261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care