MEDICARE: DAVID STEWART KOSLOV 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	208800000X	Urology Physician	DR.0060248	CO
2	208800000X	Urology Physician	A168921	CA

General Provider Information

NPI Number	:	1043655525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID STEWART KOSLOV MD

Provider Business Mailing Address
First Line	:	489 E 21ST ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4816
Country	:	US
Telephone Number	:	909-882-2973
Fax Number	:	909-882-2681

Provider Business Practice Location Address
First Line	:	489 E 21ST ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4816
Country	:	US
Telephone Number	:	909-882-2973
Fax Number	:	909-882-2681

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

Provider Enumeration Date	:	05/09/2013
Last Update Date	:	09/02/2020

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