Provider Demographics
NPI:1477878288
Name:BOHM, KYLE CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:CHRISTOPHER
Last Name:BOHM
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 1:27472 SCHOENHERR RD
Mailing Address - Street 2:140
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11900 E 12 MILE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3400
Practice Address - Country:US
Practice Address - Phone:586-216-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011092922086S0105X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery