MEDICARE: DR. BOSE YALAMANCHI MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	ME0040693	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	592420003	OTHER	FL	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194700476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOSE YALAMANCHI MD PA

Provider Business Mailing Address
First Line	:	1134 WILES RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-2114
Country	:	US
Telephone Number	:	954-344-4555
Fax Number	:	954-840-8254

Provider Business Practice Location Address
First Line	:	1134 WILES RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-2114
Country	:	US
Telephone Number	:	954-344-4555
Fax Number	:	954-840-8254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	02/20/2019

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