Healthcare Provider Details

I. General information

NPI: 1619437456
Provider Name (Legal Business Name): THOMAS JOHN KOSTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 NW 10TH AVE
MIAMI FL
33136-1054
US

IV. Provider business mailing address

1851 NW 10TH AVE
MIAMI FL
33136-1054
US

V. Phone/Fax

Practice location:
  • Phone: 305-545-2480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberOS20024
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberOS20024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: