Healthcare Provider Details

I. General information

NPI: 1982251203
Provider Name (Legal Business Name): AARON BOSCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 S LOUISE AVE STE 2100
SIOUX FALLS SD
57108-6029
US

IV. Provider business mailing address

6100 S LOUISE AVE STE 2100
SIOUX FALLS SD
57108-6029
US

V. Phone/Fax

Practice location:
  • Phone: 605-504-1100
  • Fax:
Mailing address:
  • Phone: 616-717-0752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1655
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: