Healthcare Provider Details

I. General information

NPI: 1386999357
Provider Name (Legal Business Name): NADA BOSKOVIC MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 NW DICKENS CT
BOCA RATON FL
33432-3813
US

IV. Provider business mailing address

579 NW DICKENS CT
BOCA RATON FL
33432-3813
US

V. Phone/Fax

Practice location:
  • Phone: 561-901-0044
  • Fax:
Mailing address:
  • Phone: 561-901-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME100548
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME100548
License Number StateFL

VIII. Authorized Official

Name: NADA BOSKOVIC
Title or Position: M.D.
Credential:
Phone: 561-901-0044