Healthcare Provider Details

I. General information

NPI: 1891760286
Provider Name (Legal Business Name): JAMES RICHARD KOSIUR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W. ARGYLE STREET SANILAC MEDICAL PLAZA
SANDUSKY MI
48471
US

IV. Provider business mailing address

120 N DELAWARE ST
SANDUSKY MI
48471-1009
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-6113
  • Fax: 810-648-0262
Mailing address:
  • Phone: 810-648-6113
  • Fax: 810-648-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101011746
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: