Basic Information
| Provider Information | |||||||||
| NPI: | 1174597702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOHN | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 779 | ||||||||
| Address2: | |||||||||
| City: | TAWAS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487640779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893629411 | ||||||||
| FaxNumber: | 9893629925 | ||||||||
| Practice Location | |||||||||
| Address1: | 295 MAPLE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | TAWAS CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487639352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9899843788 | ||||||||
| FaxNumber: | 9899843794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 036089196 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 29059 | IA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 38079 | 01 | BCWELLMARK | OTHER | IA01X1 | 01 | JOHN DEERE | OTHER | 3091884 | 05 | IA | MEDICAID | 1174597702 | 05 | IA | MEDICAID |