Healthcare Provider Details

I. General information

NPI: 1093796294
Provider Name (Legal Business Name): ROBERT ERIK KOSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30000 E RIVER RD
PERRYSBURG OH
43551-3429
US

IV. Provider business mailing address

30000 E RIVER RD
PERRYSBURG OH
43551-3429
US

V. Phone/Fax

Practice location:
  • Phone: 419-661-4001
  • Fax: 419-661-4015
Mailing address:
  • Phone: 419-661-4001
  • Fax: 419-661-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35042855
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35042855
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number35042855
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: