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NPI Code Detail

MEDICARE: SHYAMAL BOSE M.D.

MEDICARE: SHYAMAL BOSE M.D.
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
1207RG0100XGastroenterology Physician036-046084IL

General Provider Information

NPI Number : 1649362443
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHYAMAL BOSE M.D.
Provider Business Mailing Address
First Line : 3030 CHICAGO RD
Second Line : 3030 CHICAGO ROAD
City : STEGER
State : IL
Zip : 60475-1055
Country : US
Telephone Number : 708-756-3037
Fax Number :
Provider Business Practice Location Address
First Line : 3030 CHICAGO RD
Second Line : 3030 CHICAGO ROAD
City : STEGER
State : IL
Zip : 60475-1055
Country : US
Telephone Number : 708-756-3037
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2006
Last Update Date : 07/08/2007

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