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Individual

KEVIN JOHN BOLAK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
C.P.

Contact information

Practice address
3324 GLADE ST, MUSKEGON, MI 49444-2708
(231) 215-1419
Mailing address
1946 HORTON RD, MUSKEGON, MI 49445-1112
(231) 215-1419
(231) 744-7120

Taxonomy

Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
CP002002
DE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0F10293
BCBSM PROVIDER PIN
MI
Enumeration date
07/05/2007
Last updated
07/09/2007
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