Individual
DR. GEORGE P. BOYUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5803 NEAL AVE N, OAK PARK HEIGHTS, MN 55082-2177
(651) 439-8807
(651) 439-0232
Mailing address
5803 NEAL AVE N, OAK PARK HEIGHTS, MN 55082-2177
(651) 439-8807
(651) 439-0232
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21557
MN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
21557
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01218320
RR MEDICARE
MN
Enumeration date
08/22/2005
Last updated
11/15/2013
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