MEDICARE: DR. SUDIP K BOSE

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	L5682	TX

General Provider Information

NPI Number	:	1679537260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUDIP K BOSE

Provider Business Mailing Address
First Line	:	9229 LBJ FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-3405
Country	:	US
Telephone Number	:	972-739-3710
Fax Number	:

Provider Business Practice Location Address
First Line	:	9229 LBJ FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-3405
Country	:	US
Telephone Number	:	972-739-3710
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	03/31/2009

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Directions to “ DR. SUDIP K BOSE ” Practice Location

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