Individual
DR. KATHRYN ELAINE BOEHM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD, MS
Contact information
Practice address
424 W WOODRUFF AVE, TOLEDO, OH 43604-5027
(419) 509-6798
(866) 888-0321
Mailing address
2228 BRIDLEWOOD DR, TOLEDO, OH 43614-1003
(419) 509-6798
(866) 888-0321
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
35-05-6573-B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0744430
—
OH
05
—
2827491-180
—
MI
01
—
3159862
MEDICAID GROUP NUMBER
OH
01
—
35-05-6573-B
LICENSE
OH
Enumeration date
05/27/2005
Last updated
03/07/2023
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