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NPI Code Detail

MEDICARE: ALYSON M BOOTH MD

MEDICARE: ALYSON M BOOTH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZC0500XCytopathology Physician4301077497MI
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician4301077497MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013903848
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSON M BOOTH MD
Provider Business Mailing Address
First Line : PO BOX 209
Second Line :
City : LIMA
State : OH
Zip : 45802-0209
Country : US
Telephone Number : 866-942-0836
Fax Number : 419-223-2726
Provider Business Practice Location Address
First Line : 1105 SIXTH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2345
Country : US
Telephone Number : 231-935-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 09/18/2023

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