Individual
MICHAEL A. BOSSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4700 WATERS AVE, SAVANNAH, GA 31404
(912) 350-8180
(912) 350-8427
Mailing address
4700 WATERS AVE, SAVANNAH, GA 31404-6220
(912) 350-8180
(912) 350-8427
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
066457
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003111162A
—
GA
01
—
01457468
AMERIGROUP
GA
01
—
624791
WELLCARE
GA
05
—
GA1236
—
SC
01
—
P00955092
RAILROAD MEDICARE
GA
Enumeration date
06/11/2008
Last updated
08/07/2018
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