Individual
MR. COREY KENNETH BOEMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1500 N RITTER AVE, INDIANAPOLIS, IN 46219-3027
(317) 355-5041
Mailing address
2035 BROADWAY ST, INDIANAPOLIS, IN 46202-1760
(314) 779-8531
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1143433
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300011180
—
IN
Enumeration date
07/26/2017
Last updated
05/08/2024
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