Individual
DR. SANJAY BOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2601 KENTUCKY AVE STE 402, PADUCAH, KY 42003-3827
(270) 575-3113
(270) 575-3135
Mailing address
2605 KENTUCKY AVE, SUITE 306, PADUCAH, KY 42003-3800
(270) 415-7653
(270) 575-8359
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-095984
IL
207RC0000X
Cardiovascular Disease Physician
036-095984
IL
207RC0000X
Cardiovascular Disease Physician
43907
KY
207RI0011X
Interventional Cardiology Physician
Primary
43907
KY
207UN0901X
Nuclear Cardiology Physician
036-095984
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036095984
—
IL
05
—
7100164760
—
KY
Enumeration date
07/28/2005
Last updated
05/13/2021
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