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General NPI Number Information
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NPI Number | 1659507168
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Entity Type | Organization
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Legal Business Name | GREGORY X BOEHM, M.D. LLC
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 26777 LORAIN RD SUITE 716
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3200
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Country | US
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Telephone | 440-777-9200
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Fax | 440-777-9288
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Provider Business Mailing Address
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Address Line | 26777 LORAIN RD SUITE 716
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3200
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Country | US
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Telephone | 440-777-9200
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Fax | 440-777-9288
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY X BOEHM
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Credential | M.D.
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Telephone | 440-777-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 41394
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License Number State | OH
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