Organization
MICHAEL D BOEHM MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DANIEL BOEHM MD (OWNER / PROVIDER)
(813) 752-4646
Entity
Organization
Contact information
Practice address
1601 W REYNOLDS ST, SUITE 104, PLANT CITY, FL 33563-4748
(813) 752-4646
(813) 752-5104
Mailing address
1601 W REYNOLDS ST, SUITE 104, PLANT CITY, FL 33563-4748
(813) 752-4646
(813) 752-5104
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME55585
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271188500
—
FL
01
—
DQ3034
RAILROAD MEDICARE
—
Enumeration date
03/03/2010
Last updated
08/09/2010
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