Provider Demographics
NPI:1255310694
Name:BOES, DAVID J (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BOES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:# A201
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:2727 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3488
Practice Address - Country:US
Practice Address - Phone:517-975-3750
Practice Address - Fax:517-975-3755
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007502207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1255310694Medicaid
MIHEALTH ADVANTAGEOther252502
MI252502OtherMCLAREN HEALTH PLAN
MI4308424Medicaid
MI160C311260OtherBLUE CHOICE
MI160C311260OtherBLUE CARE NETWORK
MI0700185OtherPHYSICIANS HEALTH PLAN
MI160C311260OtherCOMMUNITY BLUE
MIF04444OtherHEALTH NET FEDERAL SERVIC
MI160C311260OtherBLUE CROSS BLUE SHIELD
MI4053266OtherAETNA
MI160C311260OtherBLUE CHOICE
MI0C36082174Medicare PIN