MEDICARE: SHYAMAL BOSE,M.D.,S.C.

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	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1992001069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHYAMAL BOSE,M.D.,S.C.

Provider Business Mailing Address
First Line	:	3030 CHICAGO RD
Second Line	:
City	:	STEGER
State	:	IL
Zip	:	60475-1055
Country	:	US
Telephone Number	:	708-756-3037
Fax Number	:	708-756-3065

Provider Business Practice Location Address
First Line	:	3030 CHICAGO RD
Second Line	:
City	:	STEGER
State	:	IL
Zip	:	60475-1055
Country	:	US
Telephone Number	:	708-756-3037
Fax Number	:	708-756-3065

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHYAMAL BOSE
Credential	:	M.D.
Telephone Number	:	708-756-3037

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	02/07/2011

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