MEDICARE: LACEY BOSHE MD

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	208000000X	Pediatrics Physician	94-10057	KS
2	208000000X	Pediatrics Physician	2022031286	MO

General Provider Information

NPI Number	:	1952861908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY BOSHE MD

Provider Business Mailing Address
First Line	:	9151 NE 81ST TER STE 240
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-1307
Country	:	US
Telephone Number	:	816-207-0070
Fax Number	:

Provider Business Practice Location Address
First Line	:	9151 NE 81ST TER STE 240
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-1307
Country	:	US
Telephone Number	:	816-207-0070
Fax Number	:

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

Provider Enumeration Date	:	03/24/2019
Last Update Date	:	08/15/2022

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Directions to “ LACEY BOSHE MD” Practice Location

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