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General NPI Number Information
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NPI Number | 1427043934
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Entity Type | Individual
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Provider Name | MARTIN A KOSCHNITZKE MD
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Gender | Male
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1760 E KEN PRATT BLVD # 201
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City | LONGMONT
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State | CO
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Zip | 80504-5311
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Country | US
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Telephone | 720-718-8222
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Fax | 720-718-5986
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Provider Business Mailing Address
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Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
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City | LOVELAND
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State | CO
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Zip | 80538-9071
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Country | US
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Telephone | 970-586-2200
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Fax | 970-577-4536
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 34193
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License Number State | CO
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