Provider Demographics
NPI:1215039722
Name:BOYE, ROGER O (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:O
Last Name:BOYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3803 SPRING STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1660
Mailing Address - Country:US
Mailing Address - Phone:262-687-8312
Mailing Address - Fax:262-687-8796
Practice Address - Street 1:3803 SPRING STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1660
Practice Address - Country:US
Practice Address - Phone:262-687-8312
Practice Address - Fax:262-687-8312
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036085330207R00000X, 207RC0200X, 207RP1001X
WI50632207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633677OtherBLUE CROSS PROVIDER #
IL036085330Medicaid
ILK02602Medicare PIN
IL036085330Medicaid