Healthcare Provider Details

I. General information

NPI: 1144647017
Provider Name (Legal Business Name): MAREN BOEHNKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 DUBLIN BLVD
COLORADO SPRINGS CO
80918-1358
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-592-9890
  • Fax: 719-264-7908
Mailing address:
  • Phone: 970-624-2417
  • Fax: 970-490-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0058401
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: