MEDICARE: MARC P BOCKNEK D.O.

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	2080A0000X	Pediatric Adolescent Medicine Physician	MB006783	MI

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

General Provider Information

NPI Number	:	1538149679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC P BOCKNEK D.O.

Provider Business Mailing Address
First Line	:	2632 S MILFORD RD
Second Line	:
City	:	HIGHLAND
State	:	MI
Zip	:	48357-4938
Country	:	US
Telephone Number	:	248-684-5510
Fax Number	:	248-684-5220

Provider Business Practice Location Address
First Line	:	2632 S MILFORD RD
Second Line	:
City	:	HIGHLAND
State	:	MI
Zip	:	48357-4938
Country	:	US
Telephone Number	:	248-684-5510
Fax Number	:	248-684-5220

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/08/2007

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