Organization
JEFFREY P. BOLDUAN, M.D. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY P BOLDUAN MD (PRESIDENT)
(574) 533-8420
Entity
Organization
Contact information
Practice address
1615 WINSTED DR STE 4, GOSHEN, IN 46526-4673
(574) 533-8420
(574) 533-3909
Mailing address
1615 WINSTED DR STE 4, GOSHEN, IN 46526-4673
(574) 533-8420
(574) 533-3909
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01030767
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100112510A
—
IN
01
—
1831278027
INDIVIDUAL NPO
IN
Enumeration date
06/23/2008
Last updated
03/11/2010
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