# DR. MICHAEL DOUGLAS BOEHM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1912984360
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 036-109140 | IL | Yes |
| 207W00000X | Ophthalmology Physician | 35141 | IA | — |
| 207WX0120X | Cornea and External Diseases Specialist Physician | 036-109140 | IL | — |
| 207WX0120X | Cornea and External Diseases Specialist Physician | 35141 | IA | — |

## Other

- **Enumeration date:** 12/28/2005
- **Last updated:** 08/14/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0060350 | IA GROUP MEDICAID \# | IA |
| 05 | — | 0290627 | — | IA |
| 05 | — | 036109146 | — | IL |
| 01 | — | 26568 | IA GROUP MEDICARE \# | IA |
| 01 | — | 790930 | IL GROUP MEDICARE \# | IL |