MEDICARE: LOURDES BOSCH MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	ME0043744	FL

General Provider Information

NPI Number	:	1013162213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOURDES BOSCH MD PA

Provider Business Mailing Address
First Line	:	351 NW LEJEUNE RD SUITE 406
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5689
Country	:	US
Telephone Number	:	305-642-2600
Fax Number	:	305-642-8887

Provider Business Practice Location Address
First Line	:	351 NW LEJEUNE RD SUITE 406
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5689
Country	:	US
Telephone Number	:	305-642-2600
Fax Number	:	305-642-8887

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LOURDES BOSCH
Credential	:	MD
Telephone Number	:	305-642-2600

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	03/23/2009

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