Provider Demographics
NPI:1275038853
Name:BOEVING, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:BOEVING
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-514-3500
Mailing Address - Fax:314-747-2598
Practice Address - Street 1:4455 DUNCAN AVE
Practice Address - Street 2:DIV ORTHO SURGERY NEUROREHAB
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1111
Practice Address - Country:US
Practice Address - Phone:314-514-3500
Practice Address - Fax:314-747-2598
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2024-04-10
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Provider Licenses
StateLicense IDTaxonomies
MO2022013873208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200111092Medicaid