Healthcare Provider Details

I. General information

NPI: 1245853274
Provider Name (Legal Business Name): WESLEY BOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 WASHINGTON AVE STE 330
HOLLAND MI
49423-7141
US

IV. Provider business mailing address

854 WASHINGTON AVE STE 330
HOLLAND MI
49423-7141
US

V. Phone/Fax

Practice location:
  • Phone: 616-355-3926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301512128
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4351046478
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: