Provider Demographics
NPI:1013951839
Name:BOSEM, MARC E (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:E
Last Name:BOSEM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2300 N COMMERCE PARKWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3255
Mailing Address - Country:US
Mailing Address - Phone:954-217-6500
Mailing Address - Fax:954-217-6506
Practice Address - Street 1:2300 N COMMERCE PARKWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3255
Practice Address - Country:US
Practice Address - Phone:954-217-6500
Practice Address - Fax:954-217-6506
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-03-19
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Provider Licenses
StateLicense IDTaxonomies
FLME0067977207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378399500Medicaid
FL37839950Medicaid
G10352Medicare UPIN
FL378399500Medicaid
FL27220Medicare PIN