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General NPI Number Information
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NPI Number | 1619087194
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Entity Type | Individual
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Provider Name | NADA MUKOSKI M.D
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 04/19/2008
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Provider Practice Location Address
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Address Line | 9330 BROADWAY
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City | CROWN POINT
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State | IN
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Zip | 46307-8602
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Country | US
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Telephone | 219-662-5019
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Fax |
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Provider Business Mailing Address
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Address Line | 10195 FLOYD ST
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City | CROWN POINT
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State | IN
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Zip | 46307-3059
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Country | US
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Telephone | 219-662-7399
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 01060837
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01060837A
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License Number State | IN
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