Provider Demographics
NPI:1083635833
Name:OHMART, BRUCE R (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:R
Last Name:OHMART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 LONG RAPIDS ROAD
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1351
Mailing Address - Country:US
Mailing Address - Phone:989-356-6191
Mailing Address - Fax:989-354-5671
Practice Address - Street 1:199 LONG RAPIDS ROAD
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1351
Practice Address - Country:US
Practice Address - Phone:989-356-6191
Practice Address - Fax:989-354-5671
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB0025398207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2000495661OtherBLUE CROSS BLUE SHIELD
MI1020438Medicaid
MI1020438Medicaid
B44375Medicare UPIN