Provider Demographics
NPI:1508867714
Name:BOSILJEVAC, JOSEPH EDWARD JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:BOSILJEVAC
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-6102
Mailing Address - Country:US
Mailing Address - Phone:620-366-1151
Mailing Address - Fax:
Practice Address - Street 1:2522 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6102
Practice Address - Country:US
Practice Address - Phone:620-366-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-16711208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS020000629OtherPALMETTO RR MEDICARE
KS100084340AMedicaid
KS001769Medicare ID - Type Unspecified
B68599Medicare UPIN