Provider Demographics
NPI:1215142500
Name:BOSE, NILANJANA (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:NILANJANA
Middle Name:
Last Name:BOSE
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 GARDEN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-7823
Mailing Address - Country:US
Mailing Address - Phone:405-513-1278
Mailing Address - Fax:
Practice Address - Street 1:11914 ASTORIA BLVD STE 355
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6076
Practice Address - Country:US
Practice Address - Phone:135-881-6747
Practice Address - Fax:713-338-2397
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine