David H. Bolonkin, DPM, Inc

Primary specialty

PodiatristTaxonomy code 213E00000X

License

07000563A Issued in IN

Legal business name

DAVID H. BOLONKIN, DPM, INC

Practice address

1402 Blackiston Mill Rd
Clarksville, IN 47129-2279

Phone

(812) 282-7701

Fax

(812) 282-7706

NPI assigned

Oct 11, 2006

Last updated

Apr 30, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David H Bolonkin, DPM

Title

Owner

Phone

(812) 282-7701

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430352000000",
    "number": "1508954561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 BLACKISTON MILL RD",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471292279",
            "telephone_number": "812-282-7701",
            "fax_number": "812-282-7706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 BLACKISTON MILL RD",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471292279",
            "telephone_number": "812-282-7701",
            "fax_number": "812-282-7706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID H. BOLONKIN, DPM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2015-04-30",
        "status": "A",
        "authorized_official_last_name": "BOLONKIN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-282-7701",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IN",
            "license": "07000563A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CL6572",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000042373",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100075780A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Clarksville, IN
• Providers in Clarksville, IN by specialty
• Podiatrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2015; 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.