Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 4301088555 | MI |
NPI | 1396956504 |
---|---|
Provider Name | Dr. Christian Bogner |
First Address | Birmingham, MI 48012-2137 |
Second Address | Brighton, MI 48116-8533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2007 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1396956504 | (05) | MI |