Provider Demographics
NPI:1598785073
Name:OZGULER, BORA (MD)
Entity Type:Individual
Prefix:
First Name:BORA
Middle Name:
Last Name:OZGULER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BORA
Other - Middle Name:
Other - Last Name:OEZGUELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16510 PRETTY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-8264
Mailing Address - Country:US
Mailing Address - Phone:814-691-7206
Mailing Address - Fax:
Practice Address - Street 1:16510 PRETTY LAKE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8264
Practice Address - Country:US
Practice Address - Phone:814-691-7206
Practice Address - Fax:574-935-2221
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35429207V00000X
PAMD446963207V00000X
ORMD195991207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201226860Medicaid
IN000000875918OtherBCBS
IN000000875918OtherBCBS
IN201226860Medicaid