Provider Demographics
NPI:1710115423
Name:BOSAK, ADAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:R
Last Name:BOSAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5750 W. THUNDERBIRD RD.
Mailing Address - Street 2:#G780
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4682
Mailing Address - Country:US
Mailing Address - Phone:602-314-4220
Mailing Address - Fax:602-314-5333
Practice Address - Street 1:5750 W. THUNDERBIRD RD.
Practice Address - Street 2:#G780
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4682
Practice Address - Country:US
Practice Address - Phone:602-314-4220
Practice Address - Fax:602-314-5333
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT2009017281207R00000X
AZ46152207RC0200X, 207PT0002X, 208M00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist