Provider Demographics
NPI:1104171743
Name:BOEHNKE, CAROLINE (MD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:BOEHNKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 LAUREL ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3044
Mailing Address - Country:US
Mailing Address - Phone:515-288-3287
Mailing Address - Fax:515-288-3200
Practice Address - Street 1:330 LAUREL ST STE 1100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3044
Practice Address - Country:US
Practice Address - Phone:515-288-3287
Practice Address - Fax:515-288-3200
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology