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General NPI Number Information
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NPI Number | 1508867714
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Entity Type | Individual
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Provider Name | JOSEPH EDWARD BOSILJEVAC JR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 07/07/2013
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Provider Practice Location Address
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Address Line | 2522 W 15TH AVE
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City | EMPORIA
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State | KS
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Zip | 66801-6102
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Country | US
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Telephone | 620-366-1151
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Fax |
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Provider Business Mailing Address
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Address Line | 2522 W 15TH AVE
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City | EMPORIA
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State | KS
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Zip | 66801-6102
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Country | US
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Telephone | 620-366-1151
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 04-16711
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License Number State | KS
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