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Individual

DR. MARC ALAN BOOTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1225 E COOLSPRING AVE STE 1-B, MICHIGAN CITY, IN 46360-6312
(219) 879-6531
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01061093A
IN
207W00000X
Ophthalmology Physician
2023-00058
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200527370
IN
Enumeration date
11/18/2005
Last updated
02/13/2023
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