Provider Demographics
NPI:1043232341
Name:BOHACH, CHRISTOPHER J (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:BOHACH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:240 W WALTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9155
Practice Address - Country:US
Practice Address - Phone:419-935-3003
Practice Address - Fax:419-933-3008
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2773213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0960349Medicaid
OH480015751OtherRAILROAD MEDICARE
OH0960349Medicaid
OH0755513Medicare PIN