Individual
STEVEN JAMES BOLLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2793 LINEVILLE RD, GREEN BAY, WI 54313-7152
(920) 496-4700
(920) 496-4704
Mailing address
PO BOX 19070, PREVEA HEALTH, GREEN BAY, WI 54307-9070
(920) 496-4700
(920) 496-4704
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31273
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31819400
—
WI
Enumeration date
07/13/2006
Last updated
07/16/2008
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