Healthcare Provider Details

I. General information

NPI: 1225459738
Provider Name (Legal Business Name): ALICIA J BOYD CNIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 AVIS DR
ANN ARBOR MI
48108-9649
US

IV. Provider business mailing address

812 AVIS DR
ANN ARBOR MI
48108-9649
US

V. Phone/Fax

Practice location:
  • Phone: 800-638-7564
  • Fax: 734-994-8457
Mailing address:
  • Phone: 800-638-7564
  • Fax: 734-994-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: