Provider Demographics
NPI:1043289150
Name:BOSKOVICH, STEVEN ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLEN
Last Name:BOSKOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3407
Mailing Address - Country:US
Mailing Address - Phone:810-732-6231
Mailing Address - Fax:810-732-0725
Practice Address - Street 1:1290 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3407
Practice Address - Country:US
Practice Address - Phone:810-732-6231
Practice Address - Fax:810-732-0725
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISB053937207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N9614001OtherMEDICARE PTAN INDIVIDUAL
MI2942116Medicaid
1802518111OtherHEALTH PLUS
C2759OtherM-CARE
1802518111OtherBCBS
1802518111OtherBLUE CARE NETWORK
MI2942116Medicaid