MEDICARE: DR. CRAIG DEAN BOREMAN 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
1	2080P0006X	Developmental - Behavioral Pediatrics Physician	35077035	OH
2	208000000X	Pediatrics Physician	35077035	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1588659015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG DEAN BOREMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 99432
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0039
Country	:	US
Telephone Number	:	937-641-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3810 POLO TRACE CT
Second Line	:
City	:	BELLBROOK
State	:	OH
Zip	:	45305-1889
Country	:	US
Telephone Number	:	937-768-5597
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	05/18/2026

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