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NPI Code Detail

MEDICARE: DR. KATHRYN ELAINE BOEHM MD, MS

MEDICARE: DR. KATHRYN ELAINE BOEHM MD, MS
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
12080A0000XPediatric Adolescent Medicine Physician35-05-6573-BOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
435-05-6573-BOTHEROHLICENSE

General Provider Information

NPI Number : 1790788248
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHRYN ELAINE BOEHM MD, MS
Provider Business Mailing Address
First Line : 2228 BRIDLEWOOD DR
Second Line :
City : TOLEDO
State : OH
Zip : 43614-1003
Country : US
Telephone Number : 419-509-6798
Fax Number : 866-888-0321
Provider Business Practice Location Address
First Line : 424 W WOODRUFF AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43604-5027
Country : US
Telephone Number : 419-509-6798
Fax Number : 866-888-0321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 03/07/2023

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