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General NPI Number Information
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NPI Number | 1164919288
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Entity Type | Individual
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Provider Name | ANNA BOSTROM MD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2018
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 200 E CHESTNUT ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-1831
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Country | US
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Telephone | 502-629-8000
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Fax | 502-629-6129
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2020017726
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 57861
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License Number State | KY
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