Provider Demographics
NPI:1972731917
Name:BOELLERT, KARL EKKEHARD JR (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:EKKEHARD
Last Name:BOELLERT
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:115 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3869
Mailing Address - Country:US
Mailing Address - Phone:864-725-7272
Mailing Address - Fax:864-725-5799
Practice Address - Street 1:115 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3869
Practice Address - Country:US
Practice Address - Phone:864-725-7272
Practice Address - Fax:864-725-5799
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC37144208100000X, 208100000X
AZ47690208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation