Provider Demographics
NPI:1912984360
Name:BOEHM, MICHAEL DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:BOEHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 TANGLEFOOT LN
Mailing Address - Street 2:EYE SURGEONS ASSOCIATES PC
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1650
Mailing Address - Country:US
Mailing Address - Phone:563-323-2020
Mailing Address - Fax:563-328-5694
Practice Address - Street 1:2001 5TH ST
Practice Address - Street 2:SUITE 49 EYE SURGEONS ASSOCIATES PC
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282
Practice Address - Country:US
Practice Address - Phone:309-792-2020
Practice Address - Fax:309-792-4753
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35141207W00000X, 207WX0120X
IL036-109140207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0290627Medicaid
IA26568OtherIA GROUP MEDICARE #
IL790930OtherIL GROUP MEDICARE #
IA0060350OtherIA GROUP MEDICAID #
IL036109146Medicaid
IL790930OtherIL GROUP MEDICARE #
IA0060350OtherIA GROUP MEDICAID #
IA26568OtherIA GROUP MEDICARE #