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1558361246

NPI Code Detail

MEDICARE: DR. DOUGLAS LEE BOERTJE MD

MEDICARE: DR. DOUGLAS LEE BOERTJE 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	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	2006-01516	NC
2	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	36257	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1558361246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS LEE BOERTJE MD

Provider Business Mailing Address
First Line	:	501 S SHARON AMITY RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-0035
Country	:	US
Telephone Number	:	704-377-2424
Fax Number	:	704-377-2687

Provider Business Practice Location Address
First Line	:	501 S SHARON AMITY RD STE 300
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-0035
Country	:	US
Telephone Number	:	704-377-2424
Fax Number	:	704-377-2687

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	08/23/2023

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Directions to “ DR. DOUGLAS LEE BOERTJE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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