Provider Demographics
NPI:1225204712
Name:BOHDAN HNATIUK, M.D., P.C.
Entity type:Organization
Organization Name:BOHDAN HNATIUK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOHDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HNATIUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-388-8175
Mailing Address - Street 1:7636 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1926
Mailing Address - Country:US
Mailing Address - Phone:313-388-8175
Mailing Address - Fax:313-388-6627
Practice Address - Street 1:7636 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1926
Practice Address - Country:US
Practice Address - Phone:313-388-8175
Practice Address - Fax:313-388-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBH034844174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4130489Medicaid
MIB46399Medicare UPIN
MIOM867000Medicare PIN