Basic Information
| Provider Information | |||||||||
| NPI: | 1255310694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOES | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 804 SERVICE RD | ||||||||
| Address2: | # A201 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488247015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178842976 | ||||||||
| FaxNumber: | 5174323928 | ||||||||
| Practice Location | |||||||||
| Address1: | 2727 S PENNSYLVANIA AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489103488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179753750 | ||||||||
| FaxNumber: | 5179753755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 06/29/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5101007502 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1255310694 | 05 | MI | MEDICAID | HEALTH ADVANTAGE | 01 | MI | 252502 | OTHER | 252502 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 4308424 | 05 | MI | MEDICAID | 160C311260 | 01 | MI | BLUE CHOICE | OTHER | 160C311260 | 01 | MI | BLUE CARE NETWORK | OTHER | 0700185 | 01 | MI | PHYSICIANS HEALTH PLAN | OTHER | 160C311260 | 01 | MI | COMMUNITY BLUE | OTHER | F04444 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER | 160C311260 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 4053266 | 01 | MI | AETNA | OTHER |