=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962462531
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH S BOSSLET MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2006
-----------------------------------------------------
Last Update Date | 01/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7174 WALDEMAR DR
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46268-2183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 463-298-2381
-----------------------------------------------------
Fax | 463-250-0183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7610 DUBONNET WAY
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46278-1542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 463-298-2381
-----------------------------------------------------
Fax | 463-250-0183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 014064886A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------