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NPI Code Detail

MEDICARE: DR. DAVID BRUCE BOSSCHER D.O.

MEDICARE: DR. DAVID BRUCE BOSSCHER D.O.
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
1207Q00000XFamily Medicine Physician02533KY
2207Q00000XFamily Medicine Physician1238TN
3207Q00000XFamily Medicine Physician510100847MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00443946OTHERMIRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10850310164OTHERMIBCBSM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3DB008747OTHERMISTATE LICENSE
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417950270
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID BRUCE BOSSCHER D.O.
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE
Second Line : MC 845
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 336 S RIVER AVE
Second Line :
City : HOLLAND
State : MI
Zip : 49423-3326
Country : US
Telephone Number : 616-394-3788
Fax Number : 616-394-3796
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 10/01/2021

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