Provider Demographics
NPI:1174798953
Name:STEPHEN BOODIN MD PC
Entity type:Organization
Organization Name:STEPHEN BOODIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOODIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-288-3200
Mailing Address - Street 1:909 W MAPLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1000
Mailing Address - Country:US
Mailing Address - Phone:248-288-3200
Mailing Address - Fax:
Practice Address - Street 1:909 W MAPLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1000
Practice Address - Country:US
Practice Address - Phone:248-288-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty