Provider Demographics
NPI:1235156175
Name:BOYSEN, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:BOYSEN
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 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-4401
Mailing Address - Fax:989-583-4409
Practice Address - Street 1:900 COOPER AVE
Practice Address - Street 2:SUITE 4400
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-4401
Practice Address - Fax:989-583-4409
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038980208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI120434OtherGREAT LAKES HEALTH PLAN
MI0200212OtherHEALTHPLUS OF MICHIGAN
MI020011145OtherRAIL ROAD MEDICARE
MI020G361410OtherBCBSM
MI381870664122OtherCOMMUNITY CHOICE MICHIGAN
MI1012201OtherMCLAREN
MI381870664OtherCOMM
MIDB038980OtherLICENSE
MI0730021OtherBCBSM
MI1235156175Medicaid
MI120434OtherGREAT LAKES HEALTH PLAN
MI1235156175Medicaid