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General NPI Number Information
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NPI Number | 1831335702
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Entity Type | Organization
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Legal Business Name | MICHAEL A. BOGDAN, MD, PLLC
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Dates
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Enumeration Date | 12/26/2008
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Last Update Date | 12/26/2008
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Provider Practice Location Address
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Address Line | 410 N CARROLL AVE SUITE 170
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6455
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Country | US
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Telephone | 817-442-1236
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Fax | 817-442-1247
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Provider Business Mailing Address
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Address Line | 410 N CARROLL AVE SUITE 170
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6455
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Country | US
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Telephone | 817-442-1236
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Fax | 817-442-1247
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL ANDREW BOGDAN
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Credential | M.D.
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Telephone | 817-442-1236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | M6055
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License Number State | TX
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