Provider Demographics
NPI:1023061165
Name:BOYKO, JEFFREY MARK (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:BOYKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 931591
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-1719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6707 POWERS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5464
Practice Address - Country:US
Practice Address - Phone:440-743-2380
Practice Address - Fax:440-743-2381
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-0057792086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2114081Medicaid
OHG87909Medicare UPIN