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NPI Code Detail

MEDICARE: MICHELLE ALISON BOJRAB MS,RDN,CD

MEDICARE: MICHELLE ALISON BOJRAB MS,RDN,CD
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
1133V00000XRegistered Dietitian37002169AIN

General Provider Information

NPI Number : 1710301809
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE ALISON BOJRAB MS,RDN,CD
Provider Business Mailing Address
First Line : 750 BROADWAY
Second Line : SUITE 150
City : FORT WAYNE
State : IN
Zip : 46802-1411
Country : US
Telephone Number : 260-423-2682
Fax Number : 260-422-4326
Provider Business Practice Location Address
First Line : 750 BROADWAY
Second Line : SUITE 350
City : FORT WAYNE
State : IN
Zip : 46802-1411
Country : US
Telephone Number : 260-423-2675
Fax Number : 260-399-4243
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2014
Last Update Date : 02/10/2014

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