Provider Demographics
NPI:1932482122
Name:MICHAEL A BOYD MD PC
Entity Type:Organization
Organization Name:MICHAEL A BOYD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-762-2332
Mailing Address - Street 1:1240 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2704
Mailing Address - Country:US
Mailing Address - Phone:931-762-2332
Mailing Address - Fax:931-762-1613
Practice Address - Street 1:1240 1ST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2704
Practice Address - Country:US
Practice Address - Phone:931-762-2332
Practice Address - Fax:931-762-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024363208600000X
KY44551208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100184210Medicaid
KY7100184210Medicaid
KYK031210Medicare PIN