Provider Demographics
NPI:1598925497
Name:BOSE, KINSHUK (MD)
Entity Type:Individual
Prefix:
First Name:KINSHUK
Middle Name:
Last Name:BOSE
Suffix:
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 1:2109 BAYSHORE BLVD UNIT 502
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3139
Mailing Address - Country:US
Mailing Address - Phone:954-701-5944
Mailing Address - Fax:
Practice Address - Street 1:2 COLUMBIA DR
Practice Address - Street 2:J402
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3683
Practice Address - Country:US
Practice Address - Phone:813-844-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN12266390200000X
FLME1065182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program