Healthcare Provider Details

I. General information

NPI: 1932669389
Provider Name (Legal Business Name): MICHAEL KOSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HIGHLAND PARK BLVD STE A
LAKELAND FL
33813-1639
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 863-816-5884
  • Fax: 863-940-4856
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS17268
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: