| Kathryn E. Boehm, Md, Llc | |
|
3454 Oak Alley Ct Suite 210 Toledo OH 43606-1306 | |
| (419) 724-6888 | |
| (419) 724-6893 |
| Full Name | Kathryn E. Boehm, Md, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 3454 Oak Alley Ct, Toledo, Ohio |
| Authorized Official Name and Position | Kathryn Elaine Boehm (SOLE PROPRIETOR) |
| Authorized Official Contact | 4197246888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathryn E. Boehm, Md, Llc 3454 Oak Alley Ct Suite 210 Toledo OH 43606-1306 Ph: (419) 724-6888 | Kathryn E. Boehm, Md, Llc 3454 Oak Alley Ct Suite 210 Toledo OH 43606-1306 Ph: (419) 724-6888 |
| NPI Number | 1104052844 |
|---|---|
| Provider Enumeration Date | 06/09/2009 |
| Last Update Date | 12/23/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104052844 | NPI | - | NPPES |
| 0744430 | Medicaid | OH | |
| 9347012 | Other | MEDICARE PTAN GROUP # | |
| KA9347011 | Other | OH | MEDICARE PTAN GROUP # |
| 3159862 | Other | OH | MEDICAID GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 35056573B (Ohio) | Primary |
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