Healthcare Provider Details

I. General information

NPI: 1093723470
Provider Name (Legal Business Name): MICHAEL F. BOHLEY M.D.,P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL F. BOHLEY M.D.,P.C.

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 SE MAIN ST STE 20
PORTLAND OR
97216-2937
US

IV. Provider business mailing address

10201 SE MAIN ST STE 20
PORTLAND OR
97216-2937
US

V. Phone/Fax

Practice location:
  • Phone: 503-253-3458
  • Fax: 503-253-0856
Mailing address:
  • Phone: 503-253-3458
  • Fax: 503-253-0856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD16132
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: