Healthcare Provider Details

I. General information

NPI: 1144464835
Provider Name (Legal Business Name): CHARLES MONTGOMERY BOYD MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 E MAPLE RD
BIRMINGHAM MI
48009-6301
US

IV. Provider business mailing address

135 E MAPLE RD
BIRMINGHAM MI
48009-6301
US

V. Phone/Fax

Practice location:
  • Phone: 248-433-1900
  • Fax: 248-433-1901
Mailing address:
  • Phone: 248-433-1900
  • Fax: 248-433-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number4301060165
License Number StateMI

VIII. Authorized Official

Name: CHARLES BOYD
Title or Position: PRESIDENT
Credential: MD
Phone: 248-433-1900