Healthcare Provider Details

I. General information

NPI: 1386970648
Provider Name (Legal Business Name): KOSSE PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 SHERMAN AVE
SAINT JOSEPH MO
64506-3649
US

IV. Provider business mailing address

3945 SHERMAN AVE
SAINT JOSEPH MO
64506-3649
US

V. Phone/Fax

Practice location:
  • Phone: 816-279-7337
  • Fax:
Mailing address:
  • Phone: 816-279-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD102761
License Number StateMO

VIII. Authorized Official

Name: DR. KARL E KOSSE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 816-279-7337