Healthcare Provider Details

I. General information

NPI: 1457791436
Provider Name (Legal Business Name): ALEXANDRA CHARLOTTE BOSSE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 GATEWAY DR STE 103
SYCAMORE IL
60178-3192
US

IV. Provider business mailing address

1850 GATEWAY DR STE 103
SYCAMORE IL
60178-3192
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-8671
  • Fax: 815-756-4892
Mailing address:
  • Phone: 815-758-8671
  • Fax: 815-756-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-138736
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: