Individual
DR. MARK WALTER BOSBOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9200 W WISCONSIN AVENUE, PLASTIC SURGERY, MILWAUKEE, WI 53226-3522
(414) 805-3666
Mailing address
9200 W WISCONSIN AVENUE, PLASTIC SURGERY, MILWAUKEE, WI 53226-3522
(414) 805-3666
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
49468-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033203906
—
WI
Enumeration date
10/03/2006
Last updated
11/27/2019
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