Provider Demographics
NPI:1326179904
Name:BOGDASARIAN, RONALD S (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:S
Last Name:BOGDASARIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5333 MCAULEY DR
Mailing Address - Street 2:SUITE 2017
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1014
Mailing Address - Country:US
Mailing Address - Phone:734-434-3200
Mailing Address - Fax:734-434-3209
Practice Address - Street 1:5333 MCAULEY DR
Practice Address - Street 2:SUITE 2017
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1014
Practice Address - Country:US
Practice Address - Phone:734-434-3200
Practice Address - Fax:734-434-3209
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRB034033207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101268OtherCARE CHOICES
MIRB034033OtherMI LICENSE NUMBER
MIC6713OtherMCARE PROVIDER ID
MI0818189OtherBCBS OF MI
MI101268OtherCARE CHOICES
MIRB034033OtherMI LICENSE NUMBER