Basic Information
| Provider Information | |||||||||
| NPI: | 1689017485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOSILJEVAC | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DUNCAN | ||||||||
| OtherFirstName: | KRISTIN | ||||||||
| OtherMiddleName: | LEE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 507 | ||||||||
| Address2: | |||||||||
| City: | LEBO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 668560507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202566346 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 118 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LEBO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 668569437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202566346 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2013 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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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 | 207Q00000X | 2013016985 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 04-39259 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.