MEDICARE: DR. JUSTIN RICHARD BOIKE 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
1	207R00000X	Internal Medicine Physician	036137165	IL
2	207RG0100X	Gastroenterology Physician	036137165	IL
3	207RT0003X	Transplant Hepatology Physician	036137165	IL
4	207RI0008X	Hepatology Physician	036137165	IL

General Provider Information

NPI Number	:	1497014294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN RICHARD BOIKE MD

Provider Business Mailing Address
First Line	:	676 N SAINT CLAIR ST
Second Line	:	STE 1400
City	:	CHICAGO
State	:	IL
Zip	:	60611-2951
Country	:	US
Telephone Number	:	312-695-4065
Fax Number	:

Provider Business Practice Location Address
First Line	:	676 N SAINT CLAIR ST STE 1400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2951
Country	:	US
Telephone Number	:	312-695-4065
Fax Number	:

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

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	04/01/2019

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