Healthcare Provider Details

I. General information

NPI: 1609837673
Provider Name (Legal Business Name): MR. JAMES BOHREN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 MICHIGAN AVE
SHEBOYGAN WI
53081-3426
US

IV. Provider business mailing address

717 MICHIGAN AVE JAMES A BOHREN BELTONE HEARING AID SERVICE
SHEBOYGAN WI
53081-3426
US

V. Phone/Fax

Practice location:
  • Phone: 920-452-0641
  • Fax: 920-452-9535
Mailing address:
  • Phone: 920-452-0641
  • Fax: 920-452-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number0205
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: