1760058549 NPI number — DR. MATTHEW JOHN BOYKO M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760058549 NPI number — DR. MATTHEW JOHN BOYKO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYKO
Provider First Name:
MATTHEW
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760058549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59 SCANLON GREEN NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALGARY
Provider Business Mailing Address State Name:
ALBERTA
Provider Business Mailing Address Postal Code:
T3L 1N6
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1403-29TH STREET NW FOOTHILLS MEDICAL CENTER
Provider Second Line Business Practice Location Address:
12TH FLOOR STROKE FELLOWS ROOM
Provider Business Practice Location Address City Name:
CALGARY
Provider Business Practice Location Address State Name:
ALBERTA
Provider Business Practice Location Address Postal Code:
T2N ZT9
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
403-944-1148
Provider Business Practice Location Address Fax Number:
403-944-3913
Provider Enumeration Date:
06/02/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)