Provider Demographics
NPI:1912334558
Name:RUBEN BOYAJIAN, MD
Entity Type:Organization
Organization Name:RUBEN BOYAJIAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-347-2255
Mailing Address - Street 1:904 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2193
Mailing Address - Country:US
Mailing Address - Phone:217-347-2255
Mailing Address - Fax:217-342-6910
Practice Address - Street 1:904 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401
Practice Address - Country:US
Practice Address - Phone:217-347-2255
Practice Address - Fax:217-342-6910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054426208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty