Individual
ROBERT BOLTUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVENUE, CLEVELAND, OH 44106
(440) 423-1356
Mailing address
3605 WARRENSVILLE CENTER ROAD, MSC 9152, SHAKER HEIGHTS, OH 44122
(216) 286-6299
(216) 286-6341
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35038688
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221019
UNISON
OH
01
—
000000516213
ANTHEM
OH
01
—
0304914
BCMH
OH
05
—
0312852
—
OH
01
—
363371
WELLCARE
OH
01
—
4230665
AETNA
OH
01
—
735110
BUCKEYE
OH
01
—
P00405346
RAILROAD MEDICARE
OH
Enumeration date
08/24/2005
Last updated
06/04/2008
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