Healthcare Provider Details

I. General information

NPI: 1003089160
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH KOSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 EISENHOWER AVE
GREAT BEND KS
67530-3213
US

IV. Provider business mailing address

1021 EISENHOWER AVE
GREAT BEND KS
67530-3213
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-5437
  • Fax:
Mailing address:
  • Phone: 620-792-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-33833
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number04-33833
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: