MEDICARE: MICHAEL D. BOBB, JR., DO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033315791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D. BOBB, JR., DO, LLC

Provider Business Mailing Address
First Line	:	5320 E MAIN ST
Second Line	:	STE 400
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2573
Country	:	US
Telephone Number	:	614-546-4691
Fax Number	:

Provider Business Practice Location Address
First Line	:	5320 E MAIN ST
Second Line	:	STE 400
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2573
Country	:	US
Telephone Number	:	614-546-4691
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHAEL D. BOBB JR.
Credential	:	D.O.
Telephone Number	:	614-322-4691

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	08/22/2020

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