Healthcare Provider Details

I. General information

NPI: 1114155041
Provider Name (Legal Business Name): JUSTIN CODY BOHRER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 BAY SHORE DR
STURGEON BAY WI
54235-2362
US

IV. Provider business mailing address

3819 BAY SHORE DR
STURGEON BAY WI
54235-2362
US

V. Phone/Fax

Practice location:
  • Phone: 608-514-4199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number60108
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number60108-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: