Healthcare Provider Details

I. General information

NPI: 1104052844
Provider Name (Legal Business Name): KATHRYN E. BOEHM, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3454 OAK ALLEY CT SUITE 210
TOLEDO OH
43606-1306
US

IV. Provider business mailing address

3454 OAK ALLEY CT SUITE 210
TOLEDO OH
43606-1306
US

V. Phone/Fax

Practice location:
  • Phone: 419-724-6888
  • Fax: 419-724-6893
Mailing address:
  • Phone: 419-724-6888
  • Fax: 419-724-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number35056573B
License Number StateOH

VIII. Authorized Official

Name: DR. KATHRYN ELAINE BOEHM
Title or Position: SOLE PROPRIETOR
Credential: MD, MS
Phone: 419-724-6888