Provider Demographics
NPI:1750848099
Name:BOYD, MARTIN PATRICK
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:PATRICK
Last Name:BOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:MI
Mailing Address - Zip Code:48756-9396
Mailing Address - Country:US
Mailing Address - Phone:810-334-5833
Mailing Address - Fax:
Practice Address - Street 1:2255 S LINDEN RD STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5417
Practice Address - Country:US
Practice Address - Phone:810-732-8087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704248691163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse