MEDICARE: MS. RUTH BOYMAN 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	207W00000X	Ophthalmology Physician	4301044945	MI

General Provider Information

NPI Number	:	1912950692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTH BOYMAN MD

Provider Business Mailing Address
First Line	:	1560 E MAPLE RD
Second Line	:	SUITE 400-CREDENTIALING
City	:	TROY
State	:	MI
Zip	:	48083-1138
Country	:	US
Telephone Number	:	313-577-8900
Fax Number	:	313-577-0700

Provider Business Practice Location Address
First Line	:	4717 SAINT ANTOINE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-1423
Country	:	US
Telephone Number	:	313-577-8900
Fax Number	:	313-577-0700

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/17/2016

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