Provider Demographics
NPI:1043257959
Name:BOZAAN, ANTHONY III (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BOZAAN
Suffix:III
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:2305 GENOA BUSINESS PARK DR
Practice Address - Street 2:STE 230
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7004
Practice Address - Country:US
Practice Address - Phone:810-494-6881
Practice Address - Fax:810-494-6882
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-03-30
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Provider Licenses
StateLicense IDTaxonomies
OH35081878208600000X
MI4301088907208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH80496Medicare UPIN