Provider Demographics
NPI:1457977217
Name:BOYD, MICHAEL JOHN
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:BOYD
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 1:2266 FIVE LAKES RD
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-9391
Mailing Address - Country:US
Mailing Address - Phone:734-255-3242
Mailing Address - Fax:
Practice Address - Street 1:2266 FIVE LAKES RD
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:MI
Practice Address - Zip Code:48455-9391
Practice Address - Country:US
Practice Address - Phone:734-255-3242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284297163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse