Healthcare Provider Details

I. General information

NPI: 1417071507
Provider Name (Legal Business Name): TONY BOGGESS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 S. MAIN STREET
ANN ARBOR MI
48104
US

IV. Provider business mailing address

1310 S. MAIN STREET
ANN ARBOR MI
48104
US

V. Phone/Fax

Practice location:
  • Phone: 734-929-2696
  • Fax: 734-929-2703
Mailing address:
  • Phone: 734-929-2696
  • Fax: 734-929-2703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number5101016620
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: