MEDICARE: DR. MYCHAJLO KOSYK MD, MPH

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
2	208200000X	Plastic Surgery Physician	57.252884	OH

General Provider Information

NPI Number	:	1720669575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYCHAJLO KOSYK MD, MPH

Provider Business Mailing Address
First Line	:	1430 TULANE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-2632
Country	:	US
Telephone Number	:	216-317-7133
Fax Number	:

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

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	01/06/2023

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