Provider Demographics
NPI:1982460838
Name:BOEHME, CONNOR R
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:R
Last Name:BOEHME
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 1:2133 CHELMSFORD LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2019
Mailing Address - Country:US
Mailing Address - Phone:419-410-0388
Mailing Address - Fax:
Practice Address - Street 1:5734 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2038
Practice Address - Country:US
Practice Address - Phone:419-724-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator