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NPI Code Detail

MEDICARE: DR. SCOTT ALLEN KOSS M.D.

MEDICARE: DR. SCOTT ALLEN KOSS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician41488-020WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265427876
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT ALLEN KOSS M.D.
Provider Business Mailing Address
First Line : 1035 KEPLER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8320
Country : US
Telephone Number : 920-490-9046
Fax Number : 262-928-7621
Provider Business Practice Location Address
First Line : 2845 GREENBRIER RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-6519
Country : US
Telephone Number : 920-288-4848
Fax Number : 920-288-4956
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 10/30/2023

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