Provider Demographics
NPI:1205049657
Name:BOYKINS, MICHAEL L (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:BOYKINS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 OLD CANTON RD STE 111
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1254
Mailing Address - Country:US
Mailing Address - Phone:601-977-9002
Mailing Address - Fax:601-977-9005
Practice Address - Street 1:6800 OLD CANTON RD STE 111
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1254
Practice Address - Country:US
Practice Address - Phone:601-977-9002
Practice Address - Fax:601-977-9005
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80090213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSY00126Medicare UPIN