Provider Demographics
NPI:1003811589
Name:BOXER, NICOLE S (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:S
Last Name:BOXER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:NICOLE
Other - Last Name:BOXER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:75 STATE ST 26TH
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-1827
Mailing Address - Country:US
Mailing Address - Phone:617-204-3500
Mailing Address - Fax:
Practice Address - Street 1:181 W EMMETT ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-2963
Practice Address - Country:US
Practice Address - Phone:269-441-3403
Practice Address - Fax:269-441-1265
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI45306050Medicaid
MIH85129Medicare UPIN
MIOP14350Medicare ID - Type Unspecified