MEDICARE: STEPHEN BOODIN MD PC

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	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1174798953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN BOODIN MD PC

Provider Business Mailing Address
First Line	:	909 W MAPLE RD
Second Line	:	SUITE 104
City	:	CLAWSON
State	:	MI
Zip	:	48017-1000
Country	:	US
Telephone Number	:	248-288-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 W MAPLE RD
Second Line	:	SUITE 104
City	:	CLAWSON
State	:	MI
Zip	:	48017-1000
Country	:	US
Telephone Number	:	248-288-3200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN E. BOODIN
Credential	:
Telephone Number	:	248-288-3200

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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