Healthcare Provider Details

I. General information

NPI: 1215142500
Provider Name (Legal Business Name): NILANJANA BOSE MD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11914 ASTORIA BLVD STE 355
HOUSTON TX
77089-6076
US

IV. Provider business mailing address

11914 ASTORIA BLVD STE 355
HOUSTON TX
77089-6076
US

V. Phone/Fax

Practice location:
  • Phone: 713-588-1674
  • Fax: 713-554-2246
Mailing address:
  • Phone: 713-588-1674
  • Fax: 713-554-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301087531
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: