Active NPI
Kristan Bolda
- Other Technician
- Clinton TWP, MI
National Provider Identifier
1811309719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 15930 19 Mile Rd
Clinton TWP, MI 48038-1155 - Phone
- (586) 464-0175
- NPI assigned
- May 27, 2014
- Last updated
- May 27, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | NU | Primary |
Addresses
Primary practice location
15930 19 Mile Rd
Clinton TWP, MI 48038-1155
Mailing address
54237 Surfside Dr
Shelby TWP, MI 48316-1458
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401148800000",
"number": "1811309719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "54237 SURFSIDE DR",
"city": "SHELBY TWP",
"state": "MI",
"postal_code": "483161458"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15930 19 MILE RD",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "480381155",
"telephone_number": "586-464-0175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDA",
"first_name": "KRISTAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-27",
"last_updated": "2014-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 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.