Dave Bolger, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036135786 Issued in IL

Practice address

4901 W 79TH St
2ND Floor
Burbank, IL 60459-1554

Phone

(708) 499-1545

Fax

(708) 499-4862

NPI assigned

Jun 1, 2011

Last updated

Aug 5, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Interoperability endpoints

• Direct secure messaging: dave.bolger.1@14940.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407196800000",
    "number": "1275827701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 W 79TH ST",
            "address_2": "2ND FLOOR",
            "city": "BURBANK",
            "state": "IL",
            "postal_code": "604591554",
            "telephone_number": "708-499-1545",
            "fax_number": "708-499-4862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 W 79TH ST",
            "address_2": "2ND FLOOR",
            "city": "BURBANK",
            "state": "IL",
            "postal_code": "604591554",
            "telephone_number": "708-499-1545",
            "fax_number": "708-499-4862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLGER",
        "first_name": "DAVE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-01",
        "last_updated": "2014-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036135786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Burbank, IL
• Providers in Burbank, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.