Organization
MIDWEST MEDICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIA RITA BOLISAY MD (PARTNER)
(812) 897-7383
Entity
Organization
Contact information
Practice address
1116 MILLIS AVE, SUITE 101, BOONVILLE, IN 47601-2242
(812) 897-7383
(812) 897-7236
Mailing address
1116 MILLIS AVE, SUITE 101, BOONVILLE, IN 47601-2242
(812) 897-7383
(812) 897-7236
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01047204
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200404200A
—
IN
Enumeration date
09/15/2006
Last updated
10/19/2007
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