| Boardman Family Practice PLLC | |
|
4713 Pine St Sw South Boardman MI 49680-9761 | |
| (231) 518-0189 | |
| (231) 518-0188 |
| Full Name | Boardman Family Practice PLLC |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 4713 Pine St Sw, South Boardman, Michigan |
| Authorized Official Name and Position | Todd Kreykes (OWNER) |
| Authorized Official Contact | 2316241054 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boardman Family Practice PLLC 4713 Pine St Sw South Boardman MI 49680-9761 Ph: (231) 518-0189 | Boardman Family Practice PLLC 4713 Pine St Sw South Boardman MI 49680-9761 Ph: (231) 518-0189 |
| NPI Number | 1740564681 |
|---|---|
| Provider Enumeration Date | 10/10/2011 |
| Last Update Date | 03/30/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740564681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 5101013379 (Michigan) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | () | Primary |
| 363A00000X | Physician Assistant | 5601002729 (Michigan) | Secondary |
Boardman Health and Wellness, PLLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4713 Pine St Sw, South Boardman, MI 49680 Phone: 231-369-2656 Fax: 231-369-2657 |