MEDICARE: DR. ALLISON KRUG KOSS D.O.

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
1	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	207Q00000X	Family Medicine Physician	OS16427	FL

General Provider Information

NPI Number	:	1265871412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON KRUG KOSS D.O.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2612

Provider Business Practice Location Address
First Line	:	1221 JACARANDA BLVD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-4520
Country	:	US
Telephone Number	:	941-766-5069
Fax Number	:	941-486-6419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	05/18/2026

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