Provider Demographics
NPI:1689017485
Name:BOSILJEVAC, KRISTIN LEE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:BOSILJEVAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LEE
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:LEBO
Mailing Address - State:KS
Mailing Address - Zip Code:66856-0507
Mailing Address - Country:US
Mailing Address - Phone:620-256-6346
Mailing Address - Fax:
Practice Address - Street 1:118 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LEBO
Practice Address - State:KS
Practice Address - Zip Code:66856-9437
Practice Address - Country:US
Practice Address - Phone:620-256-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013016985207Q00000X
KS04-39259207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine