Provider Demographics
NPI:1578701116
Name:BO, ZAW MIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ZAW
Middle Name:MIN
Last Name:BO
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 1:148 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2547
Mailing Address - Country:US
Mailing Address - Phone:937-323-5001
Mailing Address - Fax:937-323-5413
Practice Address - Street 1:148 W NORTH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2547
Practice Address - Country:US
Practice Address - Phone:937-323-5444
Practice Address - Fax:937-323-5413
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35099316207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066161Medicaid
OHH114300Medicare PIN