MEDICARE: KEVIN PATRICK BOYD M.D.

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
1	207ZD0900X	Dermatopathology (Pathology) Physician	DR.0057606	CO
2	207N00000X	Dermatology Physician	77791	WI
3	207N00000X	Dermatology Physician	21112	WI
4	207NP0225X	Pediatric Dermatology Physician	67159	MN
5	207ZD0900X	Dermatopathology (Pathology) Physician	28372	AL

General Provider Information

NPI Number	:	1215162417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN PATRICK BOYD M.D.

Provider Business Mailing Address
First Line	:	200 1ST ST SW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55905-0001
Country	:	US
Telephone Number	:	608-785-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 THEATER RD
Second Line	:
City	:	ONALASKA
State	:	WI
Zip	:	54650-8679
Country	:	US
Telephone Number	:	608-785-0940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	12/09/2022

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