Healthcare Provider Details

I. General information

NPI: 1821292723
Provider Name (Legal Business Name): MARIA N KOSSAK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22074 MICHIGAN AVE
DEARBORN MI
48124-2353
US

IV. Provider business mailing address

500 WAGNER CT
DEARBORN MI
48124-2223
US

V. Phone/Fax

Practice location:
  • Phone: 313-565-9510
  • Fax: 313-565-4410
Mailing address:
  • Phone: 313-562-4037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number5101010416
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number5101010416
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: