Provider Demographics
NPI:1992001069
Name:SHYAMAL BOSE,M.D.,S.C.
Entity Type:Organization
Organization Name:SHYAMAL BOSE,M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-756-3037
Mailing Address - Street 1:3030 CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-1055
Mailing Address - Country:US
Mailing Address - Phone:708-756-3037
Mailing Address - Fax:708-756-3065
Practice Address - Street 1:3030 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STEGER
Practice Address - State:IL
Practice Address - Zip Code:60475-1055
Practice Address - Country:US
Practice Address - Phone:708-756-3037
Practice Address - Fax:708-756-3065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12457Medicare UPIN