Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME129778 | FL |
NPI | 1053731885 |
---|---|
Provider Name | Vindya Boelke |
First Address | Lakeland, FL 33805-3019 |
Second Address | Lakeland, FL 33805-3019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2014 |
Last Update Date | 25/05/2021 |