Healthcare Provider Details

I. General information

NPI: 1689804965
Provider Name (Legal Business Name): ANDREA MARIE BOSCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA BOSCO KAKOS MD

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE MEDICAL OFFICE BUILDING, SUITE 307
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE MEDICAL OFFICE BUILDING, SUITE 307
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-3474
  • Fax: 513-585-4895
Mailing address:
  • Phone: 513-585-3474
  • Fax: 513-585-4895

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: