Provider Demographics
NPI:1215336177
Name:BOLAD ARTHRITIS & RHEUMATOLOGY CLINIC, P.A.
Entity type:Organization
Organization Name:BOLAD ARTHRITIS & RHEUMATOLOGY CLINIC, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RHEUMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-466-2996
Mailing Address - Street 1:1646 33RD ST
Mailing Address - Street 2:STE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-8866
Mailing Address - Country:US
Mailing Address - Phone:407-409-8118
Mailing Address - Fax:407-264-6562
Practice Address - Street 1:1646 33RD ST
Practice Address - Street 2:STE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-8866
Practice Address - Country:US
Practice Address - Phone:407-409-8118
Practice Address - Fax:407-264-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-17
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120763207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014446500Medicaid
FLHZ617AMedicare PIN