Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 34-005779 | OH |
NPI | 1023061165 |
---|---|
Provider Name | Jeffrey Mark Boyko |
First Address | Cleveland, OH 44193-1719 |
Second Address | Parma, OH 44129-5464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 01/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2114081 | (05) | OH |
G87909 | (02) | OH |