Healthcare Provider Details

I. General information

NPI: 1982736054
Provider Name (Legal Business Name): BRENT M BOYCE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E. MAIN ST.
SEBEWAING MI
48759-1568
US

IV. Provider business mailing address

106 E. MAIN STREET
SEBEWAING MI
48759-1568
US

V. Phone/Fax

Practice location:
  • Phone: 989-883-3800
  • Fax: 989-883-9131
Mailing address:
  • Phone: 989-883-3800
  • Fax: 989-883-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601004463
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4301074469
License Number StateMI

VIII. Authorized Official

Name: MARDI PAVLICHEK
Title or Position: OFFICE MANAGER
Credential:
Phone: 989-883-3800