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General NPI Number Information
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NPI Number | 1588772990
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Entity Type | Individual
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Provider Name | RUDY R. D. BOGOIAN III M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2006
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 20251 ARTHUR RD
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City | BIG RAPIDS
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State | MI
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Zip | 49307-9206
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Country | US
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Telephone | 231-796-2937
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Fax |
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Provider Business Mailing Address
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Address Line | 20251 ARTHUR RD
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City | BIG RAPIDS
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State | MI
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Zip | 49307-9206
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Country | US
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Telephone | 231-796-2937
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0059659
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | D0059659
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301071206
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 4301071206
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME75201
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME75201
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License Number State | FL
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