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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