Provider Demographics
NPI:1548236946
Name:BOHN, RALPH RAINER (DPM)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:RAINER
Last Name:BOHN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12017 BROOKMOOR DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2051
Mailing Address - Country:US
Mailing Address - Phone:502-244-0705
Mailing Address - Fax:502-244-3247
Practice Address - Street 1:1736 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40210-2311
Practice Address - Country:US
Practice Address - Phone:502-774-3133
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY175213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYT54200Medicare UPIN
KY2010901Medicare ID - Type Unspecified