MEDICARE: DR. WILLIAM S. BOOM

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	103TC0700X	Clinical Psychologist	6301011209	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	680D410100	OTHER	MI	BCBS OF MI

General Provider Information

NPI Number	:	1952427544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM S. BOOM

Provider Business Mailing Address
First Line	:	3252 UNIVERSITY DR STE 140
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-2783
Country	:	US
Telephone Number	:	677-289-6579
Fax Number	:

Provider Business Practice Location Address
First Line	:	3252 UNIVERSITY DR STE 140
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-2783
Country	:	US
Telephone Number	:	667-289-6579
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	02/01/2024

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Directions to “ DR. WILLIAM S. BOOM ” Practice Location

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