Provider Demographics
NPI:1174327399
Name:BOLD, ALEC (DO)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:
Last Name:BOLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LIEDERKRANZ LN
Mailing Address - Street 2:
Mailing Address - City:MILLSTADT
Mailing Address - State:IL
Mailing Address - Zip Code:62260-2266
Mailing Address - Country:US
Mailing Address - Phone:618-971-5155
Mailing Address - Fax:
Practice Address - Street 1:3691 RUTGER ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2515
Practice Address - Country:US
Practice Address - Phone:314-977-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program