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: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 WHITMORE LAKE RD
BRIGHTON MI
48116-8533
US

IV. Provider business mailing address

PO BOX 2137
BIRMINGHAM MI
48012-2137
US

V. Phone/Fax

Practice location:
  • Phone: 248-486-3636
  • Fax:
Mailing address:
  • Phone: 248-872-1200
  • Fax: 248-630-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number4301088555
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: