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General NPI Number Information
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NPI Number | 1053990804
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Entity Type | Individual
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Provider Name | MICHAEL BENJAMIN BOHNERT MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 4800 MAINE ST STE 48-200
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City | QUINCY
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State | IL
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Zip | 62305-5875
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Country | US
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Telephone | 217-214-6250
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Fax | 217-366-1767
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Provider Business Mailing Address
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Address Line | 4800 MAINE ST STE 48-200
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City | QUINCY
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State | IL
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Zip | 62305-5875
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Country | US
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Telephone | 217-214-6250
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Fax | 217-366-1767
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036.175801
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License Number State | IL
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