Provider Demographics
NPI:1255629861
Name:BOMBARD, TATYANA G (DO)
Entity type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:G
Last Name:BOMBARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TATYANA
Other - Middle Name:G
Other - Last Name:BOMBARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:E5320 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ASPIRUS IRONWOOD HOSPITAL
Practice Address - Street 2:N10561 GRAND VIEW LANE
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938
Practice Address - Country:US
Practice Address - Phone:906-932-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-17
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010221732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology