Provider Demographics
NPI:1588772990
Name:BOGOIAN, RUDY R D III (MD)
Entity type:Individual
Prefix:DR
First Name:RUDY
Middle Name:R D
Last Name:BOGOIAN
Suffix:III
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 1:20251 ARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-9206
Mailing Address - Country:US
Mailing Address - Phone:231-796-2937
Mailing Address - Fax:
Practice Address - Street 1:20251 ARTHUR RD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9206
Practice Address - Country:US
Practice Address - Phone:231-796-2937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00596592084P0800X, 2084P0804X
MI43010712062084P0800X, 2084P0804X
FLME752012084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry