Provider Demographics
NPI:1659377380
Name:BOHLING, JEFFREY LUKE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LUKE
Last Name:BOHLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:L
Other - Last Name:BOHLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4199 GATEWAY BLVD
Mailing Address - Street 2:STE 2300
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8966
Mailing Address - Country:US
Mailing Address - Phone:812-858-4610
Mailing Address - Fax:812-858-4632
Practice Address - Street 1:4199 GATEWAY BLVD
Practice Address - Street 2:STE 2300
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8966
Practice Address - Country:US
Practice Address - Phone:812-858-4610
Practice Address - Fax:812-858-4632
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022969207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100246430AMedicaid
IN637080BMedicare ID - Type Unspecified
INB29619Medicare UPIN