MEDICARE: DR. MATTHEW CINAL BOMBARD 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	207P00000X	Emergency Medicine Physician	5101020980	MI

General Provider Information

NPI Number	:	1841617446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW CINAL BOMBARD D.O.

Provider Business Mailing Address
First Line	:	15855 19 MILE RD
Second Line	:	OSTEOPATHIC MEDICINE EDUCATION SUITE 4919
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-3504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15855 19 MILE RD
Second Line	:	OSTEOPATHIC MEDICINE EDUCATION SUITE 4919
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-3504
Country	:	US
Telephone Number	:	703-663-0709
Fax Number	:

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

Provider Enumeration Date	:	03/21/2014
Last Update Date	:	08/27/2014

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