Individual
DAVID NICHOLAS BOMGAARS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6245 INKSTER RD, GARDEN CITY, MI 48135-4001
(734) 458-3412
(734) 677-7407
Mailing address
PO BOX 1108, ATTN: LYNDA THOMPSON, ANN ARBOR, MI 48106-1108
(734) 677-7400
(734) 677-7407
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
4301070875
MI
2085R0202X
Diagnostic Radiology Physician
Primary
4301070875
MI
208D00000X
General Practice Physician
4301070875
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300H220260
GROUP #
MI
01
—
3108298622
BCBS INDIVIDUAL PIN #
MI
05
—
4514997
—
MI
Enumeration date
07/02/2006
Last updated
07/06/2015
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