Basic Information
Provider Information
NPI: 1912023391
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOYD
FirstName: ANNE
MiddleName: JAMES
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5301 MCAULEY DR
Address2:  
City: YPSILANTI
State: MI
PostalCode: 481971051
CountryCode: US
TelephoneNumber: 7347123325
FaxNumber: 7347125525
Practice Location
Address1: 5301 MCAULEY DR
Address2:  
City: YPSILANTI
State: MI
PostalCode: 481971051
CountryCode: US
TelephoneNumber: 7347123325
FaxNumber: 7347125525
Other Information
ProviderEnumerationDate: 03/21/2007
LastUpdateDate: 01/26/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X4301061698MIY Allopathic & Osteopathic PhysiciansPediatrics 
2080P0202X4301061698MIN Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology

No ID Information.


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