Individual
KODY GIBSON BOLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
720 N BOND ST, SPRINGFIELD, IL 62702-4952
(217) 545-8000
(217) 545-6544
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
036.170483
IL
207Y00000X
Otolaryngology Physician
95460
GA
207YX0602X
Otolaryngic Allergy Physician
Primary
95460
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2018
Last updated
02/12/2026
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