Provider Demographics
NPI:1962668038
Name:BOSE, NEERU (MD)
Entity Type:Individual
Prefix:DR
First Name:NEERU
Middle Name:
Last Name:BOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 E 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8693
Mailing Address - Country:US
Mailing Address - Phone:219-310-2550
Mailing Address - Fax:219-310-2565
Practice Address - Street 1:342 E 109TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8693
Practice Address - Country:US
Practice Address - Phone:219-310-2550
Practice Address - Fax:219-310-2565
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072753A207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201180600Medicaid
IN201180600Medicaid