MEDICARE: COURTNEY BOGUNOVIC DPM

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	213E00000X	Podiatrist	PO3487	FL

General Provider Information

NPI Number	:	1396992715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY BOGUNOVIC DPM

Provider Business Mailing Address
First Line	:	1890 LPGA BLVD STE 230
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-7131
Country	:	US
Telephone Number	:	386-274-3336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 LPGA BLVD STE 230
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-7131
Country	:	US
Telephone Number	:	386-274-3336
Fax Number	:

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

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	03/08/2020

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Directions to “ COURTNEY BOGUNOVIC DPM” Practice Location

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