Individual
DEBARATI BANERJI BOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6701 US HIGHWAY 34, OSWEGO, IL 60543-9129
(630) 646-4255
(630) 646-4256
Mailing address
6701 US HIGHWAY 34, OSWEGO, IL 60543-9129
(630) 646-4255
(630) 646-4256
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036117495
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19828231001
—
IL
Enumeration date
04/25/2007
Last updated
03/10/2021
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