Individual
MICHAEL SCOTT BOXUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
754 MCCOOL RD, VALPARAISO, IN 46385-8856
(219) 759-5500
Mailing address
4402 SILHAVY RD, VALPARAISO, IN 46383-9157
(219) 465-3279
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02003170A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000524369
ANTHEM BLUE CROSS
IN
05
—
200860670A
—
IN
Enumeration date
02/27/2006
Last updated
09/24/2019
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