Provider Demographics
NPI:1518917871
Name:BOHL, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:BOHL
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 1:1730 W 25TH ST
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3108
Mailing Address - Country:US
Mailing Address - Phone:216-621-4060
Mailing Address - Fax:216-621-7322
Practice Address - Street 1:1730 W 25TH ST
Practice Address - Street 2:SUITE 3200
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3108
Practice Address - Country:US
Practice Address - Phone:216-621-4060
Practice Address - Fax:216-621-7322
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35035912207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00660953OtherRAILROAD MEDICARE
OH000000343859OtherANTHEM BC/BS
OHP00153933OtherRAILROAD CARE
OH350403OtherWELLCARE
OH340714684074OtherCARESOURCE
OH0335033Medicaid
OHP00660953OtherRAILROAD MEDICARE
A75841Medicare UPIN
OHP00153933OtherRAILROAD CARE