Provider Demographics
NPI:1063471670
Name:BOYKIN, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BOYKIN
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 1:122 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291
Mailing Address - Country:US
Mailing Address - Phone:318-807-4611
Mailing Address - Fax:318-807-4615
Practice Address - Street 1:122 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-807-4611
Practice Address - Fax:318-807-4615
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA109822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1148113Medicaid
LAH05015OtherVANTAGE
LAB60324Medicare UPIN
LA1148113Medicaid