MEDICARE: DR. MICHAEL C BOOTHE M.D.

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	207QB0002X	Obesity Medicine (Family Medicine) Physician	H6063	TX
2	208100000X	Physical Medicine & Rehabilitation Physician	H 6063	TX
3	207V00000X	Obstetrics & Gynecology Physician	H6063	TX

General Provider Information

NPI Number	:	1184852717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C BOOTHE M.D.

Provider Business Mailing Address
First Line	:	2819 MEDLIN DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2329
Country	:	US
Telephone Number	:	817-303-6800
Fax Number	:	817-303-6832

Provider Business Practice Location Address
First Line	:	2819 MEDLIN DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2329
Country	:	US
Telephone Number	:	817-303-6800
Fax Number	:	817-303-6832

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

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	05/06/2013

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