Healthcare Provider Details

I. General information

NPI: 1528233251
Provider Name (Legal Business Name): TOMASZ ROMAN KOSOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3129 ALTERNATE 19
DUNEDIN FL
34698-1503
US

IV. Provider business mailing address

3129 ALTERNATE 19
DUNEDIN FL
34698-1503
US

V. Phone/Fax

Practice location:
  • Phone: 305-988-0898
  • Fax: 727-265-3420
Mailing address:
  • Phone: 305-988-0898
  • Fax: 727-265-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME120247
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME120247
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: