Provider Demographics
NPI:1114911120
Name:BOYER, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:BOYER
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 1:1155 W JEFFERSON ST
Mailing Address - Street 2:STE 102
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131
Mailing Address - Country:US
Mailing Address - Phone:317-736-7603
Mailing Address - Fax:317-736-7932
Practice Address - Street 1:1155 W JEFFERSON ST
Practice Address - Street 2:STE 102
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131
Practice Address - Country:US
Practice Address - Phone:317-736-7603
Practice Address - Fax:317-736-7932
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050337208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200226880AMedicaid
IN439960GMedicare PIN
G94192Medicare UPIN