Provider Demographics
NPI:1366412827
Name:BOLD, E. LUKE (MD)
Entity type:Individual
Prefix:DR
First Name:E.
Middle Name:LUKE
Last Name:BOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:E.
Other - Middle Name:LUKE
Other - Last Name:BOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,PHD
Mailing Address - Street 1:7580 AUBURN ROAD
Mailing Address - Street 2:#103
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077
Mailing Address - Country:US
Mailing Address - Phone:440-352-1474
Mailing Address - Fax:440-352-2662
Practice Address - Street 1:7580 AUBURN ROAD
Practice Address - Street 2:#103
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-352-1474
Practice Address - Fax:440-352-2662
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-060315174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000133452OtherANTHEM
OH104632OtherKAISER
OH040006752OtherTRAVELERS RAILROAD MEDICA
OH0878153Medicaid
OH3415313198A13OtherBCBS
OH71405OtherQUALCHOICE
OH040006752OtherTRAVELERS RAILROAD MEDICA
OH104632OtherKAISER