Provider Demographics
NPI:1043859929
Name:BOYD, DOMINIQUE
Entity Type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27030 SPRUCEWOOD DR APT 202
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-3272
Mailing Address - Country:US
Mailing Address - Phone:313-471-0987
Mailing Address - Fax:
Practice Address - Street 1:27030 SPRUCEWOOD DR APT 202
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3272
Practice Address - Country:US
Practice Address - Phone:313-471-0987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-25
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health