Individual
MICHAEL BOLANOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1625 SE 3RD AVE STE 300, FORT LAUDERDALE, FL 33316-2521
(954) 355-4665
(954) 355-4881
Mailing address
1608 SE 3RD AVE FL 3, FORT LAUDERDALE, FL 33316-2564
(954) 355-4665
(954) 355-4881
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME139818
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103651500
—
FL
01
—
Q01047319
MEDICARE RR
FL
01
—
UP666
MEDICARE HF
FL
Enumeration date
06/22/2011
Last updated
10/20/2025
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