Healthcare Provider Details

I. General information

NPI: 1891934147
Provider Name (Legal Business Name): JAMES LEWIS BOSWELL II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

405 N WABASH AVE APT 1610
CHICAGO IL
60611-8500
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone: 615-414-6574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036121261
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: