Ricky Boldman

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601001019 Issued in MI

Practice address

461 W Huron St
Suite 207
Pontiac, MI 48341-1601

Phone

(248) 857-7160

NPI assigned

Mar 1, 2006

Sex

Male

Sole proprietor

No

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

Physician Assistant

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

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1437126323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 W HURON ST",
            "address_2": "SUITE 207",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483411601",
            "telephone_number": "248-857-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 W HURON ST",
            "address_2": "SUITE 207",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483411601",
            "telephone_number": "248-857-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDMAN",
        "first_name": "RICKY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-01",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601001019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Boillat, MA LLPC
• Abigail Renee Boisvert
• Braden Matthew Boji, MD
• Abdullah Bokhari, D.O.
• Shannon Boldenow
• Steven Bolton, M.D.
• Natasha Booker
• Sumaya Boomgaard, P.T.
• Melinda Claris Boone, NURSE
• Terena Boone, RN

• Physician Assistant in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.