Provider Demographics
NPI:1255863742
Name:BOKSA, AMBER (DO)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BOKSA
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 N MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8170
Mailing Address - Country:US
Mailing Address - Phone:317-344-1234
Mailing Address - Fax:
Practice Address - Street 1:10801 N MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8170
Practice Address - Country:US
Practice Address - Phone:317-344-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005985A208000000X
NJ1255863742208000000X
0000000000000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program