Provider Demographics
NPI:1447245527
Name:BOOHER, MARK A (MD)
Entity Type:Individual
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First Name:MARK
Middle Name:A
Last Name:BOOHER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5571
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:301 SATORI PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6405
Practice Address - Country:US
Practice Address - Phone:317-718-4263
Practice Address - Fax:317-272-7855
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-03-03
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Provider Licenses
StateLicense IDTaxonomies
IN01057723A207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200453300Medicaid
IN354590IIMedicare PIN
INH40100Medicare UPIN