Provider Demographics
NPI:1750349627
Name:BOGDAN, CARMEN V (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:V
Last Name:BOGDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 JOSHUA DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5267
Mailing Address - Country:US
Mailing Address - Phone:248-724-1420
Mailing Address - Fax:248-724-1420
Practice Address - Street 1:2191 SOUTH BLVD
Practice Address - Street 2:SUITE 101C
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-3479
Practice Address - Country:US
Practice Address - Phone:248-724-1420
Practice Address - Fax:248-724-1425
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104726362Medicaid
MI0N98370Medicare PIN
MI104726362Medicaid
MI0P39590Medicare PIN