Individual
KIRSTEN MARIE BOUGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-3951
Mailing address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-3951
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OT013807
PA
207RH0000X
Hematology (Internal Medicine) Physician
0S016777
PA
Other
Enumeration date
07/19/2010
Last updated
01/12/2021
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