MEDICARE: DR. STEPHEN PAUL BOGDEWIC PH.D.

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	106H00000X	Marriage & Family Therapist	35000031A	IN

General Provider Information

NPI Number	:	1366658668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN PAUL BOGDEWIC PH.D.

Provider Business Mailing Address
First Line	:	3611 E CARMEL DR
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46033-4316
Country	:	US
Telephone Number	:	317-846-4678
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 W MICHIGAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5209
Country	:	US
Telephone Number	:	317-278-0300
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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