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NPI Code Detail

MEDICARE: WALTER R BOISVERT MD

MEDICARE: WALTER R BOISVERT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician27563WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003810821
Entity Type Code : Individual
Provider Name (Legal Business Name) : WALTER R BOISVERT MD
Provider Business Mailing Address
First Line : 1836 SOUTH AVE
Second Line :
City : LA CROSSE
State : WI
Zip : 54601-5429
Country : US
Telephone Number : 608-782-7300
Fax Number :
Provider Business Practice Location Address
First Line : 610 E TAYLOR ST
Second Line :
City : PRAIRIE DU CHIEN
State : WI
Zip : 53821-2109
Country : US
Telephone Number : 608-326-6466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 09/21/2015

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