Organization
DAVID H. BOLONKIN, DPM, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID H BOLONKIN DPM (OWNER)
(812) 282-7701
Entity
Organization
Contact information
Practice address
1402 BLACKISTON MILL RD, CLARKSVILLE, IN 47129-2279
(812) 282-7701
(812) 282-7706
Mailing address
1402 BLACKISTON MILL RD, CLARKSVILLE, IN 47129-2279
(812) 282-7701
(812) 282-7706
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000563A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042373
BCBS
IN
05
—
100075780A
—
IN
01
—
CL6572
RAILROAD MEDICARE
IN
Enumeration date
10/11/2006
Last updated
04/30/2015
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