Healthcare Provider Details

I. General information

NPI: 1144377938
Provider Name (Legal Business Name): MICHELLE ELAINE KOSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 12/02/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5893 COPLEY DR KAISER GARFIELD DEPARTMENT OF UROLOGY
SAN DIEGO CA
92111-7906
US

IV. Provider business mailing address

5893 COPLEY DR KAISER GARFIELD DEPARTMENT OF UROLOGY
SAN DIEGO CA
92111-7906
US

V. Phone/Fax

Practice location:
  • Phone: 888-694-7857
  • Fax: 760-510-5782
Mailing address:
  • Phone: 888-694-7857
  • Fax: 760-510-5782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD.203505
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number34108
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberA125665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: