MEDICARE: DR. MITCHELL ANDREW KOSANOVICH 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	207P00000X	Emergency Medicine Physician	MD072543L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154323756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL ANDREW KOSANOVICH MD

Provider Business Mailing Address
First Line	:	100 S JACKSON AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15202-3428
Country	:	US
Telephone Number	:	412-734-6100
Fax Number	:	412-734-6800

Provider Business Practice Location Address
First Line	:	100 S JACKSON AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15202-3428
Country	:	US
Telephone Number	:	412-734-6100
Fax Number	:	412-734-6800

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	10/13/2020

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