Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tayt Boeckholt, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1407606080

Tayt Boeckholt, MD is a Student in an Organized Health Care Education/Training Program in Detroit, Michigan. Registered with an NPI since 2024.

In the registry since
2024
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

22151 Moross Rd Ste 214
Detroit, MI 48236-2151
Phone: (313) 343-4867
Fax: (313) 343-3280
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1407606080
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 25, 2024
Last updated in NPPESMarch 25, 2024
Certification dateMarch 25, 2024

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