Provider Demographics
NPI:1144250689
Name:BOOTH, DAVID K II (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K
Last Name:BOOTH
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 S STATE ROAD 135 STE 330
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9825
Practice Address - Country:US
Practice Address - Phone:317-497-2400
Practice Address - Fax:317-497-2515
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012260207Q00000X
IN02004083A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018551710001Medicaid
IN201089740Medicaid
INP01157043OtherRR MEDICARE PTAN
PA107996ECCMedicare PIN
INP01157043OtherRR MEDICARE PTAN
PAI69886Medicare UPIN