Provider Demographics
NPI:1336131218
Name:BOILEAU, YVETTE L (PA)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:L
Last Name:BOILEAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:585 SOUTH BLVD E STE 100
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-3163
Mailing Address - Country:US
Mailing Address - Phone:248-206-1200
Mailing Address - Fax:248-206-1206
Practice Address - Street 1:1631 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-781-9655
Practice Address - Fax:248-781-9665
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5301002599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP78131Medicare UPIN
MI0N63340Medicare ID - Type Unspecified