| NPI | 1124141171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOSE S MIKKILINENI, M.D. FACS Sole Proprietor 304-253-8416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV WV12282) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2013-01-02 |