Individual
MR. CORY MICHAEL JOHANBOEKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
913 N DIXIE AVE, ELIZABETHTOWN, KY 42701-2503
(270) 737-1212
(270) 706-1141
Mailing address
425 S HUBBARDS LN APT 237, LOUISVILLE, KY 40207-4085
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/03/2009
Last updated
09/20/2009
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