Individual
RICHARD W BOERSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10801 N MICHIGAN RD STE 110, ZIONSVILLE, IN 46077-8171
(317) 344-1269
Mailing address
10330 N MERIDIAN ST, INDIANAPOLIS, IN 46290-1024
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01028548
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000355597
ANTHEM
IL
05
—
100216200
—
IN
01
—
IN01028548
IN LIC #
IN
Enumeration date
03/22/2006
Last updated
09/15/2016
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