Healthcare Provider Details

I. General information

NPI: 1174597702
Provider Name (Legal Business Name): GREGORY A BOHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 MAPLE ST STE 200
TAWAS CITY MI
48763-9352
US

IV. Provider business mailing address

PO BOX 779
TAWAS CITY MI
48764-0779
US

V. Phone/Fax

Practice location:
  • Phone: 989-984-3788
  • Fax: 989-984-3794
Mailing address:
  • Phone: 989-362-9411
  • Fax: 989-362-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036089196
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29059
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: