Individual
DR. MICHAEL DOUGLAS BOEHM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 5TH ST, SUITE 49 EYE SURGEONS ASSOCIATES PC, SILVIS, IL 61282
(309) 792-2020
(309) 792-4753
Mailing address
777 TANGLEFOOT LN, EYE SURGEONS ASSOCIATES PC, BETTENDORF, IA 52722-1650
(563) 323-2020
(563) 328-5694
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036-109140
IL
207W00000X
Ophthalmology Physician
35141
IA
207WX0120X
Cornea and External Diseases Specialist Physician
036-109140
IL
207WX0120X
Cornea and External Diseases Specialist Physician
35141
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060350
IA GROUP MEDICAID #
IA
05
—
0290627
—
IA
05
—
036109146
—
IL
01
—
26568
IA GROUP MEDICARE #
IA
01
—
790930
IL GROUP MEDICARE #
IL
Enumeration date
12/28/2005
Last updated
08/14/2018
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