Individual
BEVERLY J BOHAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
707 ASH STREET, SPOONER, WI 54801-1903
(715) 635-2151
(715) 839-5176
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25128
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30518600
—
WI
Enumeration date
06/21/2006
Last updated
06/28/2017
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