Provider Demographics
NPI:1174597702
Name:BOHN, GREGORY A (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:BOHN
Suffix:
Gender:M
Credentials:MD
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 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-362-9411
Mailing Address - Fax:989-362-9925
Practice Address - Street 1:295 MAPLE ST STE 200
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9352
Practice Address - Country:US
Practice Address - Phone:989-984-3788
Practice Address - Fax:989-984-3794
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089196208600000X
IA29059208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
38079OtherBCWELLMARK
IA01X1OtherJOHN DEERE
IA3091884Medicaid
IA1174597702Medicaid
IA719260478Medicare PIN
I14595Medicare ID - Type UnspecifiedMEDICARE IA
A76046Medicare UPIN
P00230961Medicare ID - Type UnspecifiedRR MEDICARE