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NPI Code Detail

MEDICARE: MR. MICHAEL JOSEPH BOGDON L.I.S.W.

MEDICARE: MR. MICHAEL JOSEPH BOGDON L.I.S.W.
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
11041C0700XClinical Social WorkerI0007685OH

General Provider Information

NPI Number : 1770788382
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL JOSEPH BOGDON L.I.S.W.
Provider Business Mailing Address
First Line : PO BOX 1715
Second Line :
City : ANDOVER
State : OH
Zip : 44003-1715
Country : US
Telephone Number : 440-293-3305
Fax Number :
Provider Business Practice Location Address
First Line : 60 WEST ST
Second Line :
City : GENEVA
State : OH
Zip : 44041-9723
Country : US
Telephone Number : 440-293-3305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2007
Last Update Date : 07/08/2007

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