Healthcare Provider Details

I. General information

NPI: 1528735917
Provider Name (Legal Business Name): MICHAEL KOS MD, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501-2431
US

IV. Provider business mailing address

6506 S REGAL CT
SPOKANE WA
99223-2117
US

V. Phone/Fax

Practice location:
  • Phone: 208-799-5600
  • Fax:
Mailing address:
  • Phone: 775-560-5776
  • Fax: 530-576-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCY S CATTANEO
Title or Position: MANAGER
Credential:
Phone: 530-955-5983