Individual
SHYRLENA L BOGARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
920 WEST ST, BLDG B, PERU, IL 61354-2763
(815) 223-2944
Mailing address
1305 6TH ST, PERU, IL 61354-2759
(815) 780-5029
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
036126361
IL
207VX0000X
Obstetrics Physician
036126361
IL
261Q00000X
Clinic/Center
Primary
036.126361
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036126361
—
IL
Enumeration date
07/07/2008
Last updated
07/31/2015
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