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General NPI Number Information
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NPI Number | 1104317973
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Entity Type | Individual
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Provider Name | MICHAEL STAVIS BOHL MD, MPH, CPH, MWC
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Gender | Male
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Dates
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Enumeration Date | 05/28/2018
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 235 W 48TH ST APT 34A
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City | NEW YORK
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State | NY
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Zip | 10036-1431
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Country | US
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Telephone | 216-319-0211
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Fax |
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Provider Business Mailing Address
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Address Line | 235 W 48TH ST APT 34A
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City | NEW YORK
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State | NY
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Zip | 10036-1431
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Country | US
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Telephone | 216-319-0211
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 302345
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License Number State | NY
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