Healthcare Provider Details

I. General information

NPI: 1790375475
Provider Name (Legal Business Name): PHILIP J BOEHNLEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 TIFFIN AVE STE D
FINDLAY OH
45840-6852
US

IV. Provider business mailing address

1314 WASHINGTON AVE
FINDLAY OH
45840-5154
US

V. Phone/Fax

Practice location:
  • Phone: 419-422-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: