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General NPI Number Information
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NPI Number | 1649593773
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Entity Type | Organization
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Legal Business Name | MICHAEL D BOEHM MD PA
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 1601 W REYNOLDS ST SUITE 104
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City | PLANT CITY
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State | FL
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Zip | 33563-4748
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Country | US
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Telephone | 813-752-4646
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Fax | 813-752-5104
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Provider Business Mailing Address
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Address Line | 1601 W REYNOLDS ST SUITE 104
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City | PLANT CITY
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State | FL
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Zip | 33563-4748
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Country | US
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Telephone | 813-752-4646
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Fax | 813-752-5104
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | MICHAEL DANIEL BOEHM
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Credential | MD
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Telephone | 813-752-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME55585
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License Number State | FL
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