Provider Demographics
NPI:1093723470
Name:BOHLEY, MICHAEL F (MD,PC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:BOHLEY
Suffix:
Gender:M
Credentials:MD,PC
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:F
Other - Last Name:BOHLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,PC
Mailing Address - Street 1:10201 SE MAIN ST STE 20
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2937
Mailing Address - Country:US
Mailing Address - Phone:503-253-3458
Mailing Address - Fax:503-253-0856
Practice Address - Street 1:10201 SE MAIN ST STE 20
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2937
Practice Address - Country:US
Practice Address - Phone:503-253-3458
Practice Address - Fax:503-253-0856
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16132208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000BLBQFMedicare ID - Type Unspecified
ORF96988Medicare UPIN