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NPI Code Detail

MEDICARE: JEREMIAH JAMES BOGDONOVICH

MEDICARE: JEREMIAH JAMES BOGDONOVICH
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1295196202
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMIAH JAMES BOGDONOVICH
Provider Business Mailing Address
First Line : 517 COURT ST
Second Line : ROOM 503
City : NEILLSVILLE
State : WI
Zip : 54456-1971
Country : US
Telephone Number : 715-743-5192
Fax Number : 715-743-5209
Provider Business Practice Location Address
First Line : 517 COURT ST
Second Line : ROOM 503
City : NEILLSVILLE
State : WI
Zip : 54456-1971
Country : US
Telephone Number : 715-743-5192
Fax Number : 715-743-5209
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2016
Last Update Date : 03/18/2016

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Directions to “ JEREMIAH JAMES BOGDONOVICH ” Practice Location

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