Individual
FRED BOOTHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
3285 122ND AVE, P.O. DRAWER 130, ALLEGAN, MI 49010-9511
(269) 673-6617
(269) 673-2738
Mailing address
3285 122ND AVE, P.O. DRAWER 130, ALLEGAN, MI 49010-9511
(269) 673-6617
(269) 673-2738
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704142595
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4699274
—
MI
01
—
5008704740
BCBS
MI
Enumeration date
11/14/2005
Last updated
01/18/2008
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