Organization
BOOTH MEDICAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA N BOOTH MD (PHYSICIAN OWNER)
(260) 463-4896
Entity
Organization
Contact information
Practice address
2600 N DETROIT ST, LAGRANGE, IN 46761-1154
(260) 463-4896
(260) 463-5242
Mailing address
2600 N DETROIT ST, LAGRANGE, IN 46761-1154
(260) 463-4896
(260) 463-5242
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01041550A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100468460
—
IN
Enumeration date
11/30/2006
Last updated
07/20/2010
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