Individual
DR. MICHAEL RAY BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
445
MN
213E00000X
Podiatrist
746
WI
213ES0103X
Foot & Ankle Surgery Podiatrist
445
MN
213ES0103X
Foot & Ankle Surgery Podiatrist
746
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164225100
—
MN
05
—
43222300
—
WI
Enumeration date
10/25/2005
Last updated
04/23/2026
Update your record
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