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Organization
BOARDMAN FAMILY PRACTICE PLLC
Active
Organization
BOARDMAN FAMILY PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD KREYKES PA (OWNER)
(231) 624-1054
Entity
Organization
Contact information
Practice address
4713 PINE ST SW, SOUTH BOARDMAN, MI 49680-9761
(231) 518-0189
(231) 518-0188
Mailing address
4713 PINE ST SW, SOUTH BOARDMAN, MI 49680-9761
(231) 518-0189
(231) 518-0188
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101013379
MI
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
363A00000X
Physician Assistant
5601002729
MI
Other
Enumeration date
10/10/2011
Last updated
03/30/2016
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