Provider Demographics
NPI:1568799930
Name:BOHLEN, KEVIN SCOTT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:SCOTT
Last Name:BOHLEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:724 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2008
Mailing Address - Country:US
Mailing Address - Phone:517-784-3100
Mailing Address - Fax:517-784-3200
Practice Address - Street 1:724 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2008
Practice Address - Country:US
Practice Address - Phone:517-784-3100
Practice Address - Fax:517-784-3200
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002341363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical