Individual
NATHANIEL C BOHNERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 944-4600
(317) 948-7055
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01077564A
IN
2085R0202X
Diagnostic Radiology Physician
2015013917
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201393530
—
IN
01
—
959090043
MEDICARE PTAN
IN
Enumeration date
10/19/2010
Last updated
03/14/2024
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