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Individual

DR. ELIZABETH A BOESSENKOOL

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
950 36TH ST SW, WYOMING, MI 49509-3587
(616) 534-1640
(616) 534-4370
Mailing address
950 36TH ST SW, WYOMING, MI 49509-3587
(616) 534-1640
(616) 534-4370

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301039842
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1921891
MI
Enumeration date
05/18/2006
Last updated
07/08/2007
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