Healthcare Provider Details

I. General information

NPI: 1376285676
Provider Name (Legal Business Name): RAHUL KOSHY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-6966
  • Fax: 414-805-6980
Mailing address:
  • Phone: 414-805-6966
  • Fax: 414-805-6980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number81664-021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: