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NPI Code Detail

MEDICARE: KATHERINE IRENE BOONE

MEDICARE: KATHERINE IRENE BOONE
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
1363AS0400XSurgical Physician Assistant99032721AIN
2363AS0400XSurgical Physician Assistant10001000AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2M400063087OTHERINMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215196241
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE IRENE BOONE
Provider Business Mailing Address
First Line : PO BOX 781076
Second Line :
City : DETROIT
State : MI
Zip : 48278-1076
Country : US
Telephone Number : 317-528-4800
Fax Number : 317-865-1479
Provider Business Practice Location Address
First Line : 5255 E STOP 11 RD STE 450
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46237-6342
Country : US
Telephone Number : 317-865-4800
Fax Number : 317-865-4806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2008
Last Update Date : 03/21/2023

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Directions to “ KATHERINE IRENE BOONE ” Practice Location

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