Provider Demographics
NPI:1013455997
Name:BOE, MICHAEL B
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:BOE
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 1:40771 226TH ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55307-3502
Mailing Address - Country:US
Mailing Address - Phone:507-351-3429
Mailing Address - Fax:
Practice Address - Street 1:40771 226TH ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MN
Practice Address - Zip Code:55307-3502
Practice Address - Country:US
Practice Address - Phone:507-351-3429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program