Provider Demographics
NPI:1841213436
Name:BOCHENEK, JOHN C (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BOCHENEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13801 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4206
Mailing Address - Country:US
Mailing Address - Phone:586-757-9707
Mailing Address - Fax:586-757-9808
Practice Address - Street 1:25531 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1413
Practice Address - Country:US
Practice Address - Phone:586-757-9707
Practice Address - Fax:586-757-9808
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4126190Medicaid
OM02290006Medicare ID - Type Unspecified
MI4126190Medicaid