MEDICARE: DR. TODD CHARLES COSLETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	6692924	AZ

General Provider Information

NPI Number	:	1013485762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD CHARLES COSLETT MD

Provider Business Mailing Address
First Line	:	4149 W KALER DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-7329
Country	:	US
Telephone Number	:	484-821-6248
Fax Number	:

Provider Business Practice Location Address
First Line	:	4149 W KALER DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85055
Country	:	US
Telephone Number	:	224-267-5388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2018
Last Update Date	:	12/07/2025

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