Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01058365A | IN |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 01058365A | IN |
NPI | 1265411060 |
---|---|
Provider Name | Bhaskar David S Bose |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-1476 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 27/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200861410 | (05) | IN |
I13521 | (02) | IL |
P00393193 | RR MEDICARE (01) | IN |
P01271428 | RAILROAD MEDICARE (01) | IN |