Healthcare Provider Details

I. General information

NPI: 1568663409
Provider Name (Legal Business Name): SCOTT ALAN BOSCHEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14540 PRAIRIE LAKES BLVD N STE 200
NOBLESVILLE IN
46060-4370
US

IV. Provider business mailing address

14540 PRAIRIE LAKES BLVD N STE 200
NOBLESVILLE IN
46060-4370
US

V. Phone/Fax

Practice location:
  • Phone: 317-578-4193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01063645A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: