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General NPI Number Information
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NPI Number | 1144259086
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Entity Type | Individual
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Provider Name | DAVID NICHOLAS BOMGAARS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 6245 INKSTER RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-4001
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Country | US
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Telephone | 734-458-3412
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Fax | 734-677-7407
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Provider Business Mailing Address
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Address Line | PO BOX 1108 ATTN: LYNDA THOMPSON
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City | ANN ARBOR
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State | MI
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Zip | 48106-1108
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Country | US
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Telephone | 734-677-7400
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Fax | 734-677-7407
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301070875
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | 4301070875
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301070875
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License Number State | MI
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