Basic Information
| Provider Information | |||||||||
| NPI: | 1871703496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOLDING | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 E APPLEBY RD | ||||||||
| Address2: | STE 102, CLINIC ADMINISTRATION | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727033901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794631704 | ||||||||
| FaxNumber: | 4794637864 | ||||||||
| Practice Location | |||||||||
| Address1: | 3215 N NORTHHILLS BLVD | ||||||||
| Address2: | HOSPITAL MEDICINE GROUP | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727034424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794631000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 04/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | E-5981 | AR | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | E-5981 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 5141 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.