George P. Boyum, M.D.
Individual provider Active NPI Specialist · Oak Park Heights, MN
NPI 1528050929 · NPPES record last updated Nov 15, 2013
Key facts
- NPI
- 1528050929
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 21557 (MN)
- Practice address
- 5803 Neal Ave N
Oak Park Heights, MN 55082-2177 - Phone
- (651) 439-8807
- Fax
- (651) 439-0232
- NPI assigned
- Aug 22, 2005
- 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 |
|---|---|---|---|
| 21557 | MN | MD | Sports Medicine (Orthopaedic Surgery) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 21557 | MN | Yes |
| Sports Medicine (Orthopaedic Surgery) Physician | 207XX0005X | 21557 | MN |
Addresses
Primary practice location
5803 Neal Ave N
Oak Park Heights, MN 55082-2177
Mailing address
5803 Neal Ave N
Oak Park Heights, MN 55082-2177
Phone (651) 439-8807
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01218320 | Other | MN | RR MEDICARE |
Other providers in Oak Park Heights, MN
- Jaclyn Bailey
- Bruce J Bartie
- Aaron Benson
- Virginia Cook Borrman
- Austin A Boyer
- Tracy E Bunnell
- Emily Jean Campbell
- Gregg A Carlton
- Thomas Jason Cesarz
- Chepulis Family Eye Care, Inc.
All providers in Oak Park Heights, MN · Specialist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2013. 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.