Basic Information
| Provider Information | |||||||||
| NPI: | 1356517122 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSLER | ||||||||
| FirstName: | JAYME | ||||||||
| MiddleName: | SUSAN | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | GILGENBACH | ||||||||
| OtherFirstName: | JAYME | ||||||||
| OtherMiddleName: | SUSAN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | W129N7055 NORTHFIELD DR | ||||||||
| Address2: | REPRODUCTIVE ENDOCRINOLOGY/INFERTILITY | ||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530510538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622535400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | W129N7055 NORTHFIELD DR | ||||||||
| Address2: | REPRODUCTIVE ENDOCRINOLOGY/INFERTILITY | ||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530510538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622535400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 06/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VE0102X | 63941 | WI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 1356517122 | 05 | WI | MEDICAID |