Individual
MICHAEL BOOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
25 KINGERY CT APT 38, BELLEVILLE, IL 62226-6280
(618) 381-2886
Mailing address
25 KINGERY CT APT 38, BELLEVILLE, IL 62226-6280
(618) 381-2886
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11362192
NA
IL
Enumeration date
07/11/2022
Last updated
07/11/2022
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