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1174544530

NPI Code Detail

MEDICARE: DOROTHY C BOERSMA MD, MPH

MEDICARE: DOROTHY C BOERSMA MD, MPH

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	207Q00000X	Family Medicine Physician	01028107	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46698002	OTHER		MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1174544530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY C BOERSMA MD, MPH

Provider Business Mailing Address
First Line	:	401 E 34TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3754
Country	:	US
Telephone Number	:	317-926-1507
Fax Number	:	317-926-1508

Provider Business Practice Location Address
First Line	:	401 E 34TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3754
Country	:	US
Telephone Number	:	317-926-1507
Fax Number	:	317-926-1508

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	10/24/2016

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Directions to “ DOROTHY C BOERSMA MD, MPH” Practice Location

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