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NPI Code Detail

MEDICARE: JAMES SCOTT BOAL M.D.

MEDICARE: JAMES SCOTT BOAL M.D.
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
1207Q00000XFamily Medicine Physician4301070040MI

General Provider Information

NPI Number : 1992703672
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES SCOTT BOAL M.D.
Provider Business Mailing Address
First Line : 14100 NEWBURGH RD
Second Line :
City : LIVONIA
State : MI
Zip : 48154-5010
Country : US
Telephone Number : 734-464-7810
Fax Number : 734-779-4601
Provider Business Practice Location Address
First Line : 14100 NEWBURGH RD
Second Line :
City : LIVONIA
State : MI
Zip : 48154-5010
Country : US
Telephone Number : 734-464-7810
Fax Number : 734-779-4601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 07/08/2007

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