Provider Demographics
NPI:1033315791
Name:MICHAEL D. BOBB, JR., DO, LLC
Entity Type:Organization
Organization Name:MICHAEL D. BOBB, JR., DO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOBB
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:614-322-4691
Mailing Address - Street 1:5320 E MAIN ST
Mailing Address - Street 2:STE 400
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2573
Mailing Address - Country:US
Mailing Address - Phone:614-546-4691
Mailing Address - Fax:
Practice Address - Street 1:5320 E MAIN ST
Practice Address - Street 2:STE 400
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2573
Practice Address - Country:US
Practice Address - Phone:614-546-4691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty