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General NPI Number Information
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NPI Number | 1790280360
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Entity Type | Individual
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Provider Name | GEOFFREY ANDREW BOISVERT MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 3243 E MURDOCK ST STE 404
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City | WICHITA
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State | KS
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Zip | 67208-3007
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Country | US
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Telephone | 316-685-6222
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Fax |
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Provider Business Mailing Address
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Address Line | 424 N RUTAN ST
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City | WICHITA
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State | KS
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Zip | 67208-3217
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Country | US
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Telephone | 864-567-8301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 0450020
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0450020
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License Number State | KS
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