Provider Demographics
NPI:1326780537
Name:BOSE, GRACELYN CHERUBA (MD, MBA)
Entity Type:Individual
Prefix:
First Name:GRACELYN
Middle Name:CHERUBA
Last Name:BOSE
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13441 BOXELDER CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5500
Mailing Address - Country:US
Mailing Address - Phone:812-217-9119
Mailing Address - Fax:
Practice Address - Street 1:960 E 3RD ST STE 104
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2138
Practice Address - Country:US
Practice Address - Phone:423-778-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program