Provider Demographics
NPI:1407846637
Name:BOLIN, KRISTINE J (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:J
Last Name:BOLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13914 SOUTHEASTERN PKWY
Mailing Address - Street 2:SUITE 314
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7127
Mailing Address - Country:US
Mailing Address - Phone:317-872-1415
Mailing Address - Fax:317-337-2571
Practice Address - Street 1:13500 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1456
Practice Address - Country:US
Practice Address - Phone:317-582-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048140A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200277410Medicaid
IN200277410Medicaid
IN677690EMedicare PIN
IN160048971Medicare PIN