Michael A Bogdan, MD, FACS

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

M6055 Issued in TX

Practice address

410 N Carroll Ave
Suite 170
Southlake, TX 76092-6455

Phone

(817) 442-1236

Fax

(817) 442-1247

NPI assigned

Jul 12, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michael a. Bogdan, MD, PLLC

  • Plastic Surgery Physician
  • Southlake, TX
  • NPI 1831335702
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578873600000",
    "number": "1881629103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N CARROLL AVE",
            "address_2": "SUITE 170",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926455",
            "telephone_number": "817-442-1236",
            "fax_number": "817-442-1247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N CARROLL AVE",
            "address_2": "SUITE 170",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926455",
            "telephone_number": "817-442-1236",
            "fax_number": "817-442-1247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGDAN",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "MD, FACS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "M6055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bloom Primary TX, PLLC
• Blue Ocean Health Services LLC
• Blue Ridge Medical Solutions LLC
• Ashley Bobb
• Bobbye Records LLC
• Patricia Deanne Bolle, M.S., LPC
• Analyssia Bolton
• Grant Alexander Bond, M.D.
• Lauren Bone
• Joseph A Bonola, DDS

• Plastic Surgery Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Plastic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.