Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301109292 | MI |
Y | 2086S0105X | Surgery of the Hand | 4301109292 | MI |
NPI | 1477878288 |
---|---|
Provider Name | Kyle Christopher Bohm |
First Address | Warren, MI 48088-6688 |
Second Address | Warren, MI 48093-3400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2010 |
Last Update Date | 12/01/2017 |