Provider Demographics
NPI:1215098934
Name:BOHJANEN, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BOHJANEN
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 1:97 S 4TH ST
Mailing Address - Street 2:STE F
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-2168
Mailing Address - Country:US
Mailing Address - Phone:906-485-5771
Mailing Address - Fax:906-486-6898
Practice Address - Street 1:97 S 4TH ST
Practice Address - Street 2:STE F
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-2168
Practice Address - Country:US
Practice Address - Phone:906-485-5771
Practice Address - Fax:906-486-6898
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039485174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRB039485OtherBCBS LICENSE
MIB45045Medicare UPIN