Healthcare Provider Details

I. General information

NPI: 1255191557
Provider Name (Legal Business Name): JULIA BOSCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 ALBERT SABIN WAY
CINCINNATI OH
45267-2827
US

IV. Provider business mailing address

4231 WILLOW BROOK RD
DE PERE WI
54115-9232
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-4206
  • Fax:
Mailing address:
  • Phone: 207-522-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: