Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A129673 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | E12668 | AR |
NPI | 1154556678 |
---|---|
Provider Name | Michael Todd Bogatch |
First Address | Little Rock, AR 72211-4393 |
Second Address | Little Rock, AR 72205-6342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2009 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
237276001 | (05) | AR |