Individual
NICOLAAS IDA BOHNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
4301067813
MI
207UN0902X
Nuclear Imaging & Therapy Physician
4301067813
MI
2084N0400X
Neurology Physician
4301067813
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4806759
—
MI
Enumeration date
09/14/2006
Last updated
06/21/2019
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