Stephen Earl Boodin, M.D.
Individual provider Active NPI Neurological Surgery Physician · Clawson, MI
NPI 1093799702 · NPPES record last updated Mar 31, 2016
Key facts
- NPI
- 1093799702
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neurological Surgery Physician 207T00000X
- License
- 032164 (MI)
- Practice address
- 909 W Maple Rd
Suite 104
Clawson, MI 48017-1000 - Phone
- (248) 288-3200
- Fax
- (248) 288-0530
- NPI assigned
- Dec 6, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 032164 | MI | MD | Neurological Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | 032164 | MI | Yes |
Addresses
Primary practice location
909 W Maple Rd
Suite 104
Clawson, MI 48017-1000
Mailing address
909 W Maple Rd
Suite 104
Clawson, MI 48017-1000
Phone (248) 288-3200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2950744 | Medicaid | MI |
Other providers in Clawson, MI
- Hannah Marie Arnold
- Ferial Asmar
- Dominic Antonio Atiyeh
- Beronica Salah Bahoura
- Bodyworks Chiropratic PLLC
- Zena Boutany
- Brian Vasicek DPT PLLC
- Bruce Millman, D.O., PLLC
- Richard A Bruno
- Mende Louise Burger
All providers in Clawson, MI · Neurological Surgery Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.