Healthcare Provider Details

I. General information

NPI: 1245675024
Provider Name (Legal Business Name): PAYAL BOSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 EVERGREEN DR NE
GRAND RAPIDS MI
49525-9493
US

IV. Provider business mailing address

3259 TURNBERRY LN
ANN ARBOR MI
48108-2083
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-4200
  • Fax:
Mailing address:
  • Phone: 734-417-6062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number35.134351
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number4301500398
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: