Provider Demographics
NPI:1447201033
Name:BOHACHEVSKY, CYRIL (MD)
Entity Type:Individual
Prefix:DR
First Name:CYRIL
Middle Name:
Last Name:BOHACHEVSKY
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 1:1 MERCADO ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7300
Mailing Address - Country:US
Mailing Address - Phone:970-382-9500
Mailing Address - Fax:970-375-0007
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:STE 200
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7300
Practice Address - Country:US
Practice Address - Phone:970-382-9500
Practice Address - Fax:970-375-0007
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36938208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC69168Medicare PIN