Provider Demographics
NPI:1124151188
Name:BOERO, JOSEPH F (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:BOERO
Suffix:
Gender:M
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:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-0263
Mailing Address - Country:US
Mailing Address - Phone:715-762-2970
Mailing Address - Fax:715-762-2981
Practice Address - Street 1:1155 4TH AVE S
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1922
Practice Address - Country:US
Practice Address - Phone:715-762-2970
Practice Address - Fax:715-762-2981
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31834300Medicaid
007300238Medicare PIN