Individual
DR. MARK A BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 S HILLSDALE ST, HOMER, MI 49245-1248
(517) 568-4481
(517) 568-3720
Mailing address
420 S HILLSDALE ST, HOMER, MI 49245-1248
(517) 568-4481
(517) 568-3720
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301043850
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080157041
RAILROAD MEDICARE
MI
01
—
080A360590
BLUE CROSS BLUE SHIELD
MI
05
—
103118050
—
MI
01
—
DA0352
RAILROAD MEDICARE GROUP
MI
Enumeration date
04/19/2006
Last updated
12/05/2014
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