# BOARDMAN FAMILY PRACTICE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740564681
- **Authorized official:** TODD KREYKES PA (OWNER)
- **Authorized official phone:** (231) 624-1054

## Contact information

- **Practice address:** 4713 PINE ST SW, SOUTH BOARDMAN, MI 49680-9761
- **Practice address phone:** (231) 518-0189
- **Practice address fax:** (231) 518-0188
- **Mailing address:** 4713 PINE ST SW, SOUTH BOARDMAN, MI 49680-9761
- **Mailing address phone:** (231) 518-0189
- **Mailing address fax:** (231) 518-0188

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 5101013379 | MI | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 363A00000X | Physician Assistant | 5601002729 | MI | — |

## Other

- **Enumeration date:** 10/10/2011
- **Last updated:** 03/30/2016