Provider Demographics
NPI:1124449780
Name:BOLGER AESTHESTICS, PC
Entity type:Organization
Organization Name:BOLGER AESTHESTICS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-355-4813
Mailing Address - Street 1:5510 UTICA RIDGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2946
Mailing Address - Country:US
Mailing Address - Phone:563-355-4813
Mailing Address - Fax:563-594-5161
Practice Address - Street 1:5510 UTICA RIDGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2946
Practice Address - Country:US
Practice Address - Phone:563-355-4813
Practice Address - Fax:563-594-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service