Provider Demographics
NPI:1447253612
Name:BOSAK, MICHAEL DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DENNIS
Last Name:BOSAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3685
Mailing Address - Country:US
Mailing Address - Phone:717-920-4400
Mailing Address - Fax:717-920-4401
Practice Address - Street 1:2808 OLD POST ROAD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3685
Practice Address - Country:US
Practice Address - Phone:717-920-4400
Practice Address - Fax:717-920-4553
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055541L207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001768690Medicaid
PA025596Medicare PIN
PAG89271Medicare UPIN
PA001768690Medicaid