MEDICARE: JOHN CALVIN BOTH D.O.

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	34005250B	OH
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	34005250B	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	:	1760489322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CALVIN BOTH D.O.

Provider Business Mailing Address
First Line	:	5757 MONCLOVA RD
Second Line	:	STE 26
City	:	MAUMEE
State	:	OH
Zip	:	43537-1863
Country	:	US
Telephone Number	:	419-893-5557
Fax Number	:	419-893-5199

Provider Business Practice Location Address
First Line	:	5757 MONCLOVA RD
Second Line	:	STE 26
City	:	MAUMEE
State	:	OH
Zip	:	43537-1863
Country	:	US
Telephone Number	:	419-893-5557
Fax Number	:	419-893-5199

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	01/27/2009

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Directions to “ JOHN CALVIN BOTH D.O.” Practice Location

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