Provider Demographics
NPI:1093787749
Name:BOSE, RAJ K (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:K
Last Name:BOSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3709 N CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-838-2138
Mailing Address - Fax:
Practice Address - Street 1:2404 E RIVER RD
Practice Address - Street 2:BLD.2, STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718
Practice Address - Country:US
Practice Address - Phone:520-696-4780
Practice Address - Fax:520-408-1847
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ27633208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ515661Medicaid
AZ330005254OtherRR MEDICARE
AZZWCGCROtherGROUP MEDICARE NUMBER
AZ515661Medicaid
AZZ62582Medicare PIN