Healthcare Provider Details

I. General information

NPI: 1447646484
Provider Name (Legal Business Name): COLIN DURAND BOETTCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HOGBACK RD STE 5A
ANN ARBOR MI
48105-9750
US

IV. Provider business mailing address

7683 BADGER RUN CT
VERONA WI
53593-9031
US

V. Phone/Fax

Practice location:
  • Phone: 734-263-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number73570-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301119053
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: