Individual
DR. BOBGA S FOMUNUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1939 DIVISION AVE S, GRAND RAPIDS, MI 49507-2459
(616) 247-3815
(616) 245-0450
Mailing address
1281 INNISBROOK CT, HOLLAND, MI 49423-5502
(616) 834-7279
(616) 245-0450
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
5315017245
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1556483
—
MI
Enumeration date
08/15/2006
Last updated
01/26/2026
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