Provider Demographics
NPI:1689680449
Name:BOSHKU, ALPA (MD)
Entity Type:Individual
Prefix:
First Name:ALPA
Middle Name:
Last Name:BOSHKU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11475 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1285
Mailing Address - Country:US
Mailing Address - Phone:815-654-8000
Mailing Address - Fax:815-654-8020
Practice Address - Street 1:6595 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2542
Practice Address - Country:US
Practice Address - Phone:815-226-1300
Practice Address - Fax:815-226-1301
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036108692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH98936Medicare UPIN