MEDICARE: KENNETH BOSSLET 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
1	207Q00000X	Family Medicine Physician	4719	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831195767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH BOSSLET D.O.

Provider Business Mailing Address
First Line	:	1205 FAIRINGTON DR
Second Line	:
City	:	SIDNEY
State	:	OH
Zip	:	45365-8144
Country	:	US
Telephone Number	:	937-492-8431
Fax Number	:	937-498-5126

Provider Business Practice Location Address
First Line	:	1205 FAIRINGTON DR
Second Line	:
City	:	SIDNEY
State	:	OH
Zip	:	45365-8144
Country	:	US
Telephone Number	:	937-492-8431
Fax Number	:	937-498-5126

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	01/24/2013

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Directions to “ KENNETH BOSSLET D.O.” Practice Location

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