Basic Information
| Provider Information | |||||||||
| NPI: | 1235303215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSH | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9998 CROSSPOINT BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462563307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178068260 | ||||||||
| FaxNumber: | 3178068296 | ||||||||
| Practice Location | |||||||||
| Address1: | 9998 CROSSPOINT BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462563307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178068260 | ||||||||
| FaxNumber: | 3178068296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2008 | ||||||||
| LastUpdateDate: | 12/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 01082913A | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.