MEDICARE: DAVID C BOARDMAN DO

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	207Q00000X	Family Medicine Physician	2002006268	MO
2	207Q00000X	Family Medicine Physician	02004902A	IN

General Provider Information

NPI Number	:	1750382040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID C BOARDMAN DO

Provider Business Mailing Address
First Line	:	PO BOX 1149
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47402-1149
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 16TH ST
Second Line	:
City	:	BEDFORD
State	:	IN
Zip	:	47421-3510
Country	:	US
Telephone Number	:	812-278-8800
Fax Number	:	812-275-1343

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	12/02/2020

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Directions to “ DAVID C BOARDMAN DO” Practice Location

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