Provider Demographics
NPI:1366494270
Name:BOLMER, AMY G (DO)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:G
Last Name:BOLMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4602 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:906-225-3630
Mailing Address - Fax:906-225-4537
Practice Address - Street 1:1140 N STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1048
Practice Address - Country:US
Practice Address - Phone:906-643-0451
Practice Address - Fax:906-643-0461
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013135207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00122957OtherRAILROAD MEDICARE
MI1009476OtherMCLAREN HEALTH ADVANTAGE
MI200000001266OtherPHYSICIANS HEALTH PLAN
MI36-70041OtherPHP FAMILY CARE
MI36-00041OtherPHP
MI383267121OtherPPOM
MI7541326OtherAETNA
MI1153310564OtherBCBS/BCN
MI383267121OtherSPHN
MI383267121OtherPHCS
MI4530050Medicaid
MI36-70041OtherPHP FAMILY CARE
MI7541326OtherAETNA