Healthcare Provider Details

I. General information

NPI: 1417220138
Provider Name (Legal Business Name): MICHAEL SCOTT BOHLMAN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E ALMOND AVE SUITE 101
MADERA CA
93637-5692
US

IV. Provider business mailing address

22249 STABULIS CT
MADERA CA
93638-7813
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-1231
  • Fax:
Mailing address:
  • Phone: 559-662-0950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA94481
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA94482
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL BOHLMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 559-417-7743