Kevin John Bolak, C.P.

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

CP002002 Issued in DE

Practice address

3324 Glade St
Muskegon, MI 49444-2708

Phone

(231) 215-1419

NPI assigned

Jul 5, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1942408471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1946 HORTON RD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494451112",
            "telephone_number": "231-215-1419",
            "fax_number": "231-744-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3324 GLADE ST",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494442708",
            "telephone_number": "231-215-1419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAK",
        "first_name": "KEVIN",
        "middle_name": "JOHN",
        "credential": "C.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "DE",
            "license": "CP002002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PROVIDER PIN",
            "identifier": "0F10293",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Katherine Boes
• Theodore J Boeve, MD
• Wendy A Bohning, PTA
• Bailey Anne Bohrmann, MSW
• Anna Boik, PHARMD
• Christina Rae Bolduc, RMA
• Kara L Boley, MNT
• Rebecca Jeanette Bolli
• Jill Kristen Bollman, MS CCC A
• Elizabeth Lorene Bolthouse, MA MS LPC

• Prosthetist in Muskegon, MI
• Providers in Muskegon, MI by specialty
• Prosthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.