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General NPI Number Information
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NPI Number | 1326032830
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Entity Type | Individual
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Provider Name | BOHDAN ALEXANDER MAKAREWYCZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 1800 SULLIVAN AVE
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City | DALY CITY
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State | CA
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Zip | 94015-2228
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Country | US
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Telephone | 650-991-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 480 FAIRFAX AVE
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City | SAN MATEO
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State | CA
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Zip | 94402-2263
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Country | US
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Telephone | 650-991-1600
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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 | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | G33167
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License Number State | CA
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