Provider Demographics
NPI:1912908724
Name:BOGAR, KEVIN LEE (MD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LEE
Last Name:BOGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12000 MCCRACKEN ROAD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-663-8686
Mailing Address - Fax:216-663-2153
Practice Address - Street 1:12000 MCCRACKEN ROAD
Practice Address - Street 2:SUITE 550
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125
Practice Address - Country:US
Practice Address - Phone:216-663-8686
Practice Address - Fax:216-663-2153
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35076810B207R00000X
OH35076810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2135997Medicaid
OHBO0889773Medicare ID - Type Unspecified
OH2135997Medicaid
OHB00889771Medicare PIN