KODY GIBSON BOLK

SPRINGFIELD, IL
NPI1669976023
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207YX0602X Otolaryngology, Otolaryngic Allergy
(Licence: GA  95460)
Additional Taxonomies207Y00000X Otolaryngology
(Licence: IL  036.170483)
207Y00000X Otolaryngology
(Licence: GA  95460)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2018-03-21
Last Update Date2026-02-12
Business Address
KODY GIBSON BOLK MD
720 N BOND ST
SPRINGFIELD, IL 62702-4952
Phone number: 217-545-8000
Mailing Address
KODY GIBSON BOLK MD
PO BOX 19639
SPRINGFIELD, IL 62794-9639
Phone number: 217-545-8000