Provider Demographics
NPI:1134382120
Name:BOSE, LOHITH (MD)
Entity type:Individual
Prefix:DR
First Name:LOHITH
Middle Name:
Last Name:BOSE
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 1:2160 S 1ST AVE
Mailing Address - Street 2:EMS BLDG 110, ROOM 3210
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-327-3041
Mailing Address - Fax:708-327-3489
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:EMS BLDG 110, ROOM 3210
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-327-3041
Practice Address - Fax:708-327-3489
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131640208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery