Healthcare Provider Details

I. General information

NPI: 1215039722
Provider Name (Legal Business Name): ROGER O BOYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 SPRING STREET SUITE 600
RACINE WI
53405-1660
US

IV. Provider business mailing address

3803 SPRING STREET SUITE 600
RACINE WI
53405-1660
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-8312
  • Fax: 262-687-8312
Mailing address:
  • Phone: 262-687-8312
  • Fax: 262-687-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036085330
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036085330
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036085330
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number50632
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: