Provider Demographics
NPI:1417220138
Name:MICHAEL SCOTT BOHLMAN MD INC
Entity Type:Organization
Organization Name:MICHAEL SCOTT BOHLMAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-417-7743
Mailing Address - Street 1:22249 STABULIS CT
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-7813
Mailing Address - Country:US
Mailing Address - Phone:559-662-0950
Mailing Address - Fax:
Practice Address - Street 1:1100 E ALMOND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5692
Practice Address - Country:US
Practice Address - Phone:559-675-1231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94482207Q00000X
CAA94481208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty