Provider Demographics
NPI:1639520422
Name:BOEVE, MATTHEW JAY (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAY
Last Name:BOEVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 S STATE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-2067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 S STATE ST
Practice Address - Street 2:STE 200
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-2067
Practice Address - Country:US
Practice Address - Phone:616-741-9720
Practice Address - Fax:616-741-9725
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022307204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM