Healthcare Provider Details

I. General information

NPI: 1992746556
Provider Name (Legal Business Name): DAVID W KOSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MAPLE ST
WOODRUFF WI
54568-0470
US

IV. Provider business mailing address

240 MAPLE ST PO BOX 470
WOODRUFF WI
54568-0470
US

V. Phone/Fax

Practice location:
  • Phone: 715-356-8000
  • Fax: 715-356-8286
Mailing address:
  • Phone: 715-356-8000
  • Fax: 715-356-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number24963-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: