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NPI Code Detail

MEDICARE: JOHN R BOARDMAN MD

MEDICARE: JOHN R BOARDMAN 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
1207P00000XEmergency Medicine Physician27561WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3930111410OTHERWIRAILROAD

General Provider Information

NPI Number : 1487682696
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN R BOARDMAN MD
Provider Business Mailing Address
First Line : 2629 N 7TH ST
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53083-4932
Country : US
Telephone Number : 920-451-5553
Fax Number : 920-451-5113
Provider Business Practice Location Address
First Line : 2629 N 7TH ST
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53083-4932
Country : US
Telephone Number : 920-451-5553
Fax Number : 920-451-5113
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 08/26/2008

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