Individual
DR. MELISSA SUE BOSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3707 NEW VISION DR, FORT WAYNE, IN 46845-1702
(260) 469-4763
Mailing address
3707 NEW VISION DR, FORT WAYNE, IN 46845-1702
(260) 469-4763
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301095084
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301095084
MI
Other
Enumeration date
06/30/2009
Last updated
01/27/2016
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