Provider Demographics
NPI:1528061702
Name:BOOSE, ERIC WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:BOOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6701 ROCKSIDE RD
Mailing Address - Street 2:STE 260
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2351
Mailing Address - Country:US
Mailing Address - Phone:216-369-2525
Mailing Address - Fax:216-369-2531
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:STE 260
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2351
Practice Address - Country:US
Practice Address - Phone:216-369-2525
Practice Address - Fax:216-369-2531
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35081506B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH350411OtherWELLCARE
OH000000489324OtherANTHEM
OHT81506OtherSUMMACARE
OH2332952Medicaid
OH000000489324OtherANTHEM
OHP00713821Medicare PIN
OHH62056Medicare UPIN
BO4083433Medicare PIN
OHP00316486Medicare PIN