Healthcare Provider Details

I. General information

NPI: 1437157724
Provider Name (Legal Business Name): GUILLERMO BOHM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4061 BONITA BEACH RD STE 101
BONITA SPRINGS FL
34134-4073
US

IV. Provider business mailing address

PO BOX 62707
FORT MYERS FL
33906-2707
US

V. Phone/Fax

Practice location:
  • Phone: 239-301-0105
  • Fax: 239-301-0110
Mailing address:
  • Phone: 239-931-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME65227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: