Individual
DAVID K BOOTH II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3000 S STATE ROAD 135 STE 330, GREENWOOD, IN 46143-9825
(317) 497-2400
(317) 497-2515
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004083A
IN
207Q00000X
Family Medicine Physician
OS012260
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018551710001
—
PA
05
—
201089740
—
IN
01
—
P01157043
RR MEDICARE PTAN
IN
Enumeration date
07/03/2006
Last updated
04/24/2025
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