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NPI Code Detail

MEDICARE: BOGGS FAMILY MEDICINE PC

MEDICARE: BOGGS FAMILY MEDICINE PC
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
1261QP2300XPrimary Care Clinic/Center5101019010MI

General Provider Information

NPI Number : 1932549896
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOGGS FAMILY MEDICINE PC
Provider Business Mailing Address
First Line : 25620 GIBRALTAR RD
Second Line :
City : FLAT ROCK
State : MI
Zip : 48134-1243
Country : US
Telephone Number : 734-789-9355
Fax Number :
Provider Business Practice Location Address
First Line : 25620 GIBRALTAR RD
Second Line :
City : FLAT ROCK
State : MI
Zip : 48134-1243
Country : US
Telephone Number : 734-789-9355
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. NICHOLAS E BOGGS
Credential : D.O.
Telephone Number : 734-789-9355
Provider Enumeration Date : 06/25/2013
Last Update Date : 06/25/2013

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Directions to “BOGGS FAMILY MEDICINE PC ” Practice Location

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