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NPI Code Detail

MEDICARE: MRS. LAQUITA PATRICE BOYEDE MD

MEDICARE: MRS. LAQUITA PATRICE BOYEDE 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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1124591185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAQUITA PATRICE BOYEDE MD
Provider Business Mailing Address
First Line : 638 SOUTH IDA STREET DYNAMIC MEDICAL SERVICES LLC.
Second Line :
City : WICHITA
State : KS
Zip : 67211
Country : US
Telephone Number : 240-505-1283
Fax Number : 316-395-1110
Provider Business Practice Location Address
First Line : 1503 NORTHEAST PARKWAY
Second Line :
City : WICHITA
State : KS
Zip : 67214
Country : US
Telephone Number : 877-340-3242
Fax Number : 316-395-1110
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2019
Last Update Date : 01/02/2019

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