Provider Demographics
NPI:1306818729
Name:BOEHM, MAUREEN (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BOEHM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 WADSWORTH BLVD
Mailing Address - Street 2:#201
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4641
Mailing Address - Country:US
Mailing Address - Phone:720-898-9612
Mailing Address - Fax:720-898-9614
Practice Address - Street 1:4350 WADSWORTH BLVD
Practice Address - Street 2:#201
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4641
Practice Address - Country:US
Practice Address - Phone:720-898-9612
Practice Address - Fax:720-898-9614
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98627732Medicaid
COH37361Medicare UPIN