Provider Demographics
NPI:1417950270
Name:BOSSCHER, DAVID BRUCE (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRUCE
Last Name:BOSSCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:336 S RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3326
Practice Address - Country:US
Practice Address - Phone:616-394-3788
Practice Address - Fax:616-394-3796
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02533207Q00000X
TN1238207Q00000X
MI510100847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0850310164OtherBCBSM
KY64025331Medicaid
MIDB008747OtherSTATE LICENSE
MIP00443946OtherRAILROAD MEDICARE
MI115223241OtherMI MEDICAID
MIP00443946OtherRAILROAD MEDICARE
B47045Medicare UPIN
KY0297009Medicare ID - Type Unspecified
TN3305354Medicare ID - Type Unspecified
MIDB008747OtherSTATE LICENSE