John Bolden M.D. S.C.

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

036106844 Issued in IL

Legal business name

JOHN BOLDEN M.D. S.C.

Practice address

114 W Waverly St
Morris, IL 60450-1422

Phone

(708) 349-0055

NPI assigned

Nov 28, 2007

Organization subpart

No

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

Authorized official

Name

John Bolden Jr., M.D.

Title

Owner

Phone

(708) 349-0055

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296691200000",
    "number": "1891977294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10660 W 143RD ST STE B",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604621989",
            "telephone_number": "708-349-0055",
            "fax_number": "708-460-8031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 W WAVERLY ST",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501422",
            "telephone_number": "708-349-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN BOLDEN M.D. S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-28",
        "last_updated": "2011-02-03",
        "status": "A",
        "authorized_official_last_name": "BOLDEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-349-0055",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "IL",
            "license": "036106844",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO RR MEDICARE",
            "identifier": "DE2561",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "03232029",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036106844",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David W James
• Linda G Jandura, RN
• Cary Ann Jenkins, MD
• Jennifer L. Jones, M.D., LLC
• Jessica Brelje Physical Therapy
• Brooke John
• Kenneth Johnson
• Richard Charles Johnson, MD
• Joliet Oncology Hematology Associates LTD.
• Cooper Elaine Jones

• Infectious Disease Physician in Morris, IL
• Providers in Morris, IL by specialty
• Infectious Disease Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; 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.