Provider Demographics
NPI:1922051358
Name:BOYD, KATHERINE L (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:BOYD
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 1:26240 HARBOUR POINTE DR S
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3215
Mailing Address - Country:US
Mailing Address - Phone:586-746-0869
Mailing Address - Fax:
Practice Address - Street 1:28755 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4378
Practice Address - Country:US
Practice Address - Phone:586-573-7222
Practice Address - Fax:586-573-7267
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKB054361207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160504146OtherBCN OF MICHIGAN
MI3466204Medicaid
MI160404146OtherBCBS OF MICHIGAN
MI160404146OtherBCBS OF MICHIGAN
MI0504146Medicare ID - Type Unspecified