Individual provider Active NPI

Shree Bose, MD, PHD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1013601632
Registry record updated Jun 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125.082543 Issued in IL
Practice address
5841 S Maryland Ave Ste Mc7082
Chicago, IL 60637-1465
Phone
(773) 702-6840
Fax
(773) 702-2230
NPI assigned
Jun 6, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125.082543 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave Ste Mc7082
Chicago, IL 60637-1465

Mailing address

180 Harvester Dr Ste 110
Burr Ridge, IL 60527-6686
Phone (773) 702-1150

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230712003321 IL Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 9931569704

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
125.082543ILMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1013601632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 HARVESTER DR STE 110",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276686",
            "telephone_number": "773-702-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE STE MC7082",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371465",
            "telephone_number": "773-702-6840",
            "fax_number": "773-702-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSE",
        "first_name": "SHREE",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-06",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125.082543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.