Healthcare Provider Details

I. General information

NPI: 1396956504
Provider Name (Legal Business Name): CHRISTIAN BOGNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43313 WOODWARD AVE # 1105
BLOOMFIELD HILLS MI
48302-5007
US

IV. Provider business mailing address

43313 WOODWARD AVE # 1105
BLOOMFIELD HILLS MI
48302-5007
US

V. Phone/Fax

Practice location:
  • Phone: 248-931-8811
  • Fax: 866-465-1916
Mailing address:
  • Phone: 248-931-8811
  • Fax: 866-465-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number4301088555
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number4301088555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: