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Individual

WILLEM H BOOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-8500
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714

Taxonomy

Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
35-057716
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000224351
UNISON
01
000000539533
ANTHEM
01
0642326
AETNA
OH
05
0728163
OH
01
363372
WELLCARE
01
700006744
RAILROAD MEDICARE
OH
01
746006
BUCKEYE
OH
01
P00449264
RAILROAD MEDICARE
OH
Enumeration date
07/19/2006
Last updated
12/10/2020
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