Provider Demographics
NPI:1740245240
Name:BOSWORTH, HOBART H (MD)
Entity Type:Individual
Prefix:
First Name:HOBART
Middle Name:H
Last Name:BOSWORTH
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 1:1450 EASTSIDE RD
Mailing Address - Street 2:STE 110
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-9800
Mailing Address - Country:US
Mailing Address - Phone:608-348-4330
Mailing Address - Fax:608-342-4801
Practice Address - Street 1:1450 EASTSIDE RD
Practice Address - Street 2:STE 110
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-9800
Practice Address - Country:US
Practice Address - Phone:608-348-4330
Practice Address - Fax:608-342-4810
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39499-020207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8044OtherDEAN HEALTH INSURANCE
WI32399600Medicaid
WI1024976OtherPHYSICIANS PLUS
WI009157155Medicare PIN
WI1024976OtherPHYSICIANS PLUS
F01041Medicare UPIN
WI040013342Medicare PIN