Michel Adeodat Boileau, MD
Individual provider Active NPI Urology Physician · Bend, OR
NPI 1316909773 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1316909773
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Urology Physician 208800000X
- License
- MD09307 (OR)
- Practice address
- 2090 NE Wyatt CT
Suite 101
Bend, OR 97701-7687 - Phone
- (541) 382-6447
- Fax
- (541) 330-7413
- NPI assigned
- Apr 3, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| MD09307 | OR | MD | Urology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | MD09307 | OR | Yes |
Addresses
Primary practice location
2090 NE Wyatt CT
Suite 101
Bend, OR 97701-7687
Mailing address
2090 NE Wyatt CT
Suite 101
Bend, OR 97701-7687
Phone (541) 382-6447
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 128207 | Medicaid | OR |
Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.