Individual
MARK A. BOOHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 SATORI PKWY, SUITE 120, AVON, IN 46123-6405
(317) 718-4263
(317) 272-7855
Mailing address
1100 SOUTHFIELD DR, SUITE 1370, PLAINFIELD, IN 46168-4498
(317) 837-5571
(317) 837-5580
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01057723A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200453300
—
IN
Enumeration date
09/15/2005
Last updated
03/03/2021
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