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NPI Code Detail

MEDICARE: MAKENNA BOGAARD

MEDICARE: MAKENNA BOGAARD
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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1235868951
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKENNA BOGAARD
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1777 AXTELL DR STE 202
Second Line :
City : TROY
State : MI
Zip : 48084-4435
Country : US
Telephone Number : 248-594-3142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2022
Last Update Date : 06/10/2022

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Directions to “ MAKENNA BOGAARD ” Practice Location

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