Healthcare Provider Details

I. General information

NPI: 1255310694
Provider Name (Legal Business Name): DAVID J BOES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 S PENNSYLVANIA AVE
LANSING MI
48910-3488
US

IV. Provider business mailing address

804 SERVICE RD # A201
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-3750
  • Fax: 517-975-3755
Mailing address:
  • Phone: 517-884-2976
  • Fax: 517-432-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101007502
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: