MEDICARE: MADELINE BOJI

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
1	363A00000X	Physician Assistant	5601010753	MI

General Provider Information

NPI Number	:	1023789443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE BOJI

Provider Business Mailing Address
First Line	:	5334 TRILLIUM CT
Second Line	:
City	:	ORCHARD LAKE
State	:	MI
Zip	:	48323-1577
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5334 TRILLIUM CT
Second Line	:
City	:	ORCHARD LAKE
State	:	MI
Zip	:	48323-1577
Country	:	US
Telephone Number	:	248-921-1871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/29/2021

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Directions to “ MADELINE BOJI ” Practice Location

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