MEDICARE: GUILLERMO BOHM MD

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME65227	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	23687A	OTHER	FL	BC BS

General Provider Information

NPI Number	:	1437157724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUILLERMO BOHM MD

Provider Business Mailing Address
First Line	:	PO BOX 62707
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33906-2707
Country	:	US
Telephone Number	:	239-931-3440
Fax Number	:

Provider Business Practice Location Address
First Line	:	4061 BONITA BEACH RD STE 101
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4073
Country	:	US
Telephone Number	:	239-301-0105
Fax Number	:	239-301-0110

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	01/10/2020

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