MEDICARE: MICHAEL WILFRED PROSPER BOOS JR. 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	207V00000X	Obstetrics & Gynecology Physician	13759	LA

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	:	1932109451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WILFRED PROSPER BOOS JR. MD

Provider Business Mailing Address
First Line	:	4640 AMBASSADOR CAFFERY PKWY
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6902
Country	:	US
Telephone Number	:	337-984-1050
Fax Number	:	337-984-8776

Provider Business Practice Location Address
First Line	:	4640 AMBASSADOR CAFFERY PKWY
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6902
Country	:	US
Telephone Number	:	337-984-1050
Fax Number	:	337-984-8776

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	09/24/2013

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