MEDICARE: DR. ALAN RUSSELL KOSLOW 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
1	2086S0129X	Vascular Surgery Physician	30390	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	38296	OTHER	IA	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1427004464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN RUSSELL KOSLOW M.D.

Provider Business Mailing Address
First Line	:	974 73RD ST
Second Line	:	SUITE 23
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1024
Country	:	US
Telephone Number	:	515-284-1976
Fax Number	:	515-223-3010

Provider Business Practice Location Address
First Line	:	974 73RD ST
Second Line	:	SUITE 23
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1024
Country	:	US
Telephone Number	:	515-284-1976
Fax Number	:	515-223-3010

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/23/2010

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