Provider Demographics
NPI:1255710430
Name:BOEKELHEIDE, LUCY (MD)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:BOEKELHEIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:44250 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1002
Mailing Address - Country:US
Mailing Address - Phone:248-964-0400
Mailing Address - Fax:248-964-0401
Practice Address - Street 1:500 RENAISSANCE CTR STE R560
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48243-1929
Practice Address - Country:US
Practice Address - Phone:313-473-3800
Practice Address - Fax:313-473-3800
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301107294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine