Basic Information
| Provider Information | |||||||||
| NPI: | 1609223593 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSSE | ||||||||
| FirstName: | BRADLEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | UW HOSPITALS & CLINICS 600 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537920001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082636400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 CITY DRIVE | ||||||||
| Address2: | BUILDING 56, SUITE 812 RT. 8 | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144568224 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2016 | ||||||||
| LastUpdateDate: | 05/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 72896 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.