MEDICARE: DR. MICHAEL STEPHEN BOGARD DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	20A17716	CA

General Provider Information

NPI Number	:	1114412939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL STEPHEN BOGARD DO

Provider Business Mailing Address
First Line	:	PO BOX 13061
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92039-3061
Country	:	US
Telephone Number	:	714-465-7064
Fax Number	:	858-703-1001

Provider Business Practice Location Address
First Line	:	8929 UNIVERSITY CENTER LN STE 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1054
Country	:	US
Telephone Number	:	858-703-1000
Fax Number	:	858-703-1001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	04/07/2026

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