Healthcare Provider Details

I. General information

NPI: 1205954765
Provider Name (Legal Business Name): ANNA MANION BOOHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MARIE MANION

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SIXTH ST STE 200
TRAVERSE CITY MI
49684-2369
US

IV. Provider business mailing address

809 E MICHIGAN AVE
GRAYLING MI
49738-1417
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-5800
  • Fax: 231-935-5799
Mailing address:
  • Phone: 989-348-0530
  • Fax: 989-234-8327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number4301079969
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License Number4301079969
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301079969
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301079969
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301079969
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: