| Organization Name: | MICHAEL T. BOLLINGER, MD, A PROFESSIONAL CORPORATION |
| NPI Number: | 1558535419 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL THOMAS BOLLINGER (CEO/PHYSICIAN) |
| Mailing Address: | 555 Petaluma Ave Ste B Sebastopol |
| State: | CA US |
| Postal Code: | 954724225 |
| Phone Number: | 7078237602 |
| Fax Number: | 7078237625 |
| NPI Enumeration Date: | 04/22/2008 |
| NPI Last Update Date: | 06/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | A65404 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |