Healthcare Provider Details

I. General information

NPI: 1083091185
Provider Name (Legal Business Name): CARA BOSCO MARTINEZ P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARA M BOSCO PA

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9576 HWY 70
MINOCQUA WI
54548-9067
US

IV. Provider business mailing address

4266 WOODLANDS LN
ORCHARD LAKE MI
48323-1675
US

V. Phone/Fax

Practice location:
  • Phone: 715-358-1000
  • Fax:
Mailing address:
  • Phone: 248-683-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-06328
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006966
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3979
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: