# JEFFREY P. BOLDUAN, M.D. INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538320577
- **Authorized official:** DR. JEFFREY P BOLDUAN MD (PRESIDENT)
- **Authorized official phone:** (574) 533-8420

## Contact information

- **Practice address:** 1615 WINSTED DR STE 4, GOSHEN, IN 46526-4673
- **Practice address phone:** (574) 533-8420
- **Practice address fax:** (574) 533-3909
- **Mailing address:** 1615 WINSTED DR STE 4, GOSHEN, IN 46526-4673
- **Mailing address phone:** (574) 533-8420
- **Mailing address fax:** (574) 533-3909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 01030767 | IN | Yes |

## Other

- **Enumeration date:** 06/23/2008
- **Last updated:** 03/11/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100112510A | — | IN |
| 01 | — | 1831278027 | INDIVIDUAL NPO | IN |