Michael Boose
Individual provider Active NPI Homemaker · Belleville, IL
NPI 1104550706 · NPPES record last updated Jul 11, 2022
Key facts
- NPI
- 1104550706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Homemaker 376J00000X
- Practice address
- 25 Kingery CT Apt 38
Belleville, IL 62226-6280 - Phone
- (618) 381-2886
- NPI assigned
- Jul 11, 2022
- 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)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker | 376J00000X | Yes |
Addresses
Primary practice location
25 Kingery CT Apt 38
Belleville, IL 62226-6280
Mailing address
25 Kingery CT Apt 38
Belleville, IL 62226-6280
Phone (618) 381-2886
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11362192 | Other | IL | NA |
Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2022. 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.