Provider Demographics
NPI:1063882595
Name:NOTBOHM, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NOTBOHM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33672-1103
Mailing Address - Country:US
Mailing Address - Phone:813-540-6733
Mailing Address - Fax:
Practice Address - Street 1:6012 YEATS MANOR DR
Practice Address - Street 2:UNIT 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-1444
Practice Address - Country:US
Practice Address - Phone:813-540-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-27
Last Update Date:2015-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography