Provider Demographics
NPI:1528081635
Name:HNATIUK, BOHDAN (MD)
Entity type:Individual
Prefix:DR
First Name:BOHDAN
Middle Name:
Last Name:HNATIUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 MONROE ST
Mailing Address - Street 2:STE B
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3057
Mailing Address - Country:US
Mailing Address - Phone:313-730-8000
Mailing Address - Fax:313-730-8962
Practice Address - Street 1:7636 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1926
Practice Address - Country:US
Practice Address - Phone:313-388-8175
Practice Address - Fax:313-388-6627
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034844207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2654OtherCAPE
MI160048717OtherMEDICARE RAILROAD
MI125213OtherCARECHOICES
MI0829068OtherBCBSM
MI4130489Medicaid
MI4228005OtherAETNA
MIB6210OtherMCARE
MI4228005OtherAETNA
MIB6210OtherMCARE