Provider Demographics
NPI:1447251624
Name:BOYER, MICHAEL J (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BOYER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-2286
Mailing Address - Country:US
Mailing Address - Phone:330-334-1534
Mailing Address - Fax:330-334-1535
Practice Address - Street 1:119 BROAD ST
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1851
Practice Address - Country:US
Practice Address - Phone:330-334-1534
Practice Address - Fax:330-334-1535
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002426213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0696751Medicaid
OH0613062Medicare PIN
OH0696751Medicaid
OH0204680001Medicare NSC