Provider Demographics
NPI:1699168104
Name:BOLICK, MICHAEL SINCLAIR
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SINCLAIR
Last Name:BOLICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4251
Mailing Address - Country:US
Mailing Address - Phone:843-229-0312
Mailing Address - Fax:
Practice Address - Street 1:401 S FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4251
Practice Address - Country:US
Practice Address - Phone:843-229-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-08
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106709367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered