Healthcare Provider Details

I. General information

NPI: 1699979476
Provider Name (Legal Business Name): BARBARA I COSLOW N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

IV. Provider business mailing address

2442 DORCHESTER DR N #103
TROY MI
48084-3755
US

V. Phone/Fax

Practice location:
  • Phone: 248-898-0046
  • Fax: 248-898-1276
Mailing address:
  • Phone: 248-816-0824
  • Fax: 248-898-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704107713
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4704107713
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: