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General NPI Number Information
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NPI Number | 1790788248
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Entity Type | Individual
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Provider Name | KATHRYN ELAINE BOEHM MD, MS
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Gender | Female
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 424 W WOODRUFF AVE
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City | TOLEDO
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State | OH
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Zip | 43604-5027
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Country | US
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Telephone | 419-509-6798
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Fax | 866-888-0321
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Provider Business Mailing Address
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Address Line | 2228 BRIDLEWOOD DR
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City | TOLEDO
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State | OH
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Zip | 43614-1003
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Country | US
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Telephone | 419-509-6798
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Fax | 866-888-0321
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 35-05-6573-B
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License Number State | OH
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