Provider Demographics
NPI:1033473350
Name:BOKSHAN, ALYSON R (MD)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:R
Last Name:BOKSHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4350 JACKSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1889
Mailing Address - Country:US
Mailing Address - Phone:734-971-9344
Mailing Address - Fax:734-971-2303
Practice Address - Street 1:4350 JACKSON RD STE 100
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1889
Practice Address - Country:US
Practice Address - Phone:734-971-9344
Practice Address - Fax:734-971-2303
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012020961208000000X
MI4301111606208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics