MEDICARE: BALEIGH BOGNAR

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1083463913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BALEIGH BOGNAR

Provider Business Mailing Address
First Line	:	1080 NIMITZVIEW DR STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4332
Country	:	US
Telephone Number	:	419-309-3991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1080 NIMITZVIEW DR STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4332
Country	:	US
Telephone Number	:	419-309-3991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/14/2024

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Directions to “ BALEIGH BOGNAR ” Practice Location

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