Organization
KATHRYN E. BOEHM, MD, LLC
Active
Organization
KATHRYN E. BOEHM, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHRYN ELAINE BOEHM MD, MS (SOLE PROPRIETOR)
(419) 724-6888
Entity
Organization
Contact information
Practice address
3454 OAK ALLEY CT, SUITE 210, TOLEDO, OH 43606-1306
(419) 724-6888
(419) 724-6893
Mailing address
3454 OAK ALLEY CT, SUITE 210, TOLEDO, OH 43606-1306
(419) 724-6888
(419) 724-6893
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
35056573B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0744430
—
OH
01
—
3159862
MEDICAID GROUP NUMBER
OH
01
—
9347012
MEDICARE PTAN GROUP #
—
01
—
KA9347011
MEDICARE PTAN GROUP #
OH
Enumeration date
06/09/2009
Last updated
12/23/2011
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