MEDICARE: DR. JACQUELINE KOSHOREK D.O

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	2084N0400X	Neurology Physician	009660	AZ

General Provider Information

NPI Number	:	1346690252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE KOSHOREK D.O

Provider Business Mailing Address
First Line	:	3370 N HAYDEN RD
Second Line	:	SUITE 123 PMB 283
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15255 N 40TH ST
Second Line	:	SUITE 127/129, ROOM 1
City	:	PHOENIX
State	:	AZ
Zip	:	85032
Country	:	US
Telephone Number	:	602-759-9438
Fax Number	:

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

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	05/27/2026

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