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General NPI Number Information
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NPI Number | 1295200327
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Entity Type | Individual
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Provider Name | RYAN MICHAEL KOSEK PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 4300 MARKET PTE DR STE 100
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City | BLOOMINGTON
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State | MN
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Zip | 55435-5435
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Country | US
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Telephone | 952-767-4574
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Fax |
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Provider Business Mailing Address
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Address Line | 407 E 3RD ST
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City | DULUTH
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State | MN
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Zip | 55805-1950
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Country | US
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Telephone | 218-786-4000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7089-23
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0005591
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14104
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License Number State | MN
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