Joseph Edward Bosiljevac Jr., MD
Individual provider Active NPI Surgery Physician · Emporia, KS
NPI 1508867714 · NPPES record last updated Jul 7, 2013
Key facts
- NPI
- 1508867714
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 04-16711 (KS)
- Practice address
- 2522 W 15TH Ave
Emporia, KS 66801-6102 - Phone
- (620) 366-1151
- NPI assigned
- Aug 10, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04-16711 | KS | MD | Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 04-16711 | KS | Yes |
Addresses
Primary practice location
2522 W 15TH Ave
Emporia, KS 66801-6102
Mailing address
2522 W 15TH Ave
Emporia, KS 66801-6102
Phone (620) 366-1151
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020000629 | Other | KS | PALMETTO RR MEDICARE |
| 100084340A | Medicaid | KS |
Other providers in Emporia, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.