MEDICARE: ANTONYA BOATMAN

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	335E00000X	Prosthetic/Orthotic Supplier
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1578354924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONYA BOATMAN

Provider Business Mailing Address
First Line	:	2209 N DR MARTIN LUTHER KING JR DR STE 203
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-3188
Country	:	US
Telephone Number	:	602-791-0397
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 N DR MARTIN LUTHER KING JR DR STE 203
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-3188
Country	:	US
Telephone Number	:	602-791-0397
Fax Number	:

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

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/15/2025

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Directions to “ ANTONYA BOATMAN ” Practice Location

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