Individual
MR. BEAU BOEDECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2801 W KINNICKINNIC RIVER PKWY STE 550, MILWAUKEE, WI 53215-3696
(414) 385-7150
(414) 385-7159
Mailing address
6250 THORNRIDGE LN, GREENDALE, WI 53129-2651
(414) 303-8332
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2701-23
WI
Other
Enumeration date
02/15/2011
Last updated
01/03/2022
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