License Search: Details

Name	Title	Specialty	Certified	Primary Practice Location	Licensed Or Has Been Licensed In
Douglas Paul Bosack	MD	Cardiovascular Disease Internal Medicine	Verify Specialty Certification	Greenvalley Medical Center 202 Maplewood Ave RONCEVERTE, WV (Greenbrier)	IN, MI, OH

License History

License Type	License Number	Status	License Date	Expiration Date
PMD	21789	Revoked by Board	12/15/2004	05/27/2005

Education History

School	Date Completed	Nature of Training
University Of Cincinnati College Of Medicine	06/11/1978	Medical or Podiatric School
Henry Ford Hospital, Detroit	6/30/1983	Post-Graduate Training

Physician Assistant(s) Collaboration

Name
No Current Supervision

Discipline/Board Action History

Discipline/Board Action	Type of Action	Action Date	Public Documents
Yes	Probation of License	12/10/2004	Consent Order
Yes	Revocation of License	4/22/2005	Final Order

Malpractice History

No Malpractice Cases On Record

This data was retrieved on 4/20/2026.