MEDICARE: DR. MICHAEL V BOURN DO

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	207P00000X	Emergency Medicine Physician	34-00-4435-B	OH
2	207PH0002X	Hospice and Palliative Medicine (Emergency Medicine) Physician	34.007735	OH
3	207RA0401X	Addiction Medicine (Internal Medicine) Physician	34.007735	OH
4	208VP0014X	Interventional Pain Medicine Physician	34.007735	OH
5	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	61-21847	OH

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	:	1548292519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL V BOURN DO

Provider Business Mailing Address
First Line	:	5368 STOCKTON CT
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-8602
Country	:	US
Telephone Number	:	614-598-6588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1161 BETHEL RD STE 203
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2773
Country	:	US
Telephone Number	:	614-459-0350
Fax Number	:	614-456-0355

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	05/20/2022

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Directions to “ DR. MICHAEL V BOURN DO” Practice Location

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