Provider Demographics
NPI:1154397404
Name:BOOTH, DAVID G (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:BOOTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:866-611-1512
Mailing Address - Fax:231-727-4451
Practice Address - Street 1:3535 PARK ST STE 110
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3736
Practice Address - Country:US
Practice Address - Phone:231-672-3155
Practice Address - Fax:231-672-3157
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301046159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4556191Medicaid
MIA73237Medicare UPIN