MEDICARE: KOSOBUCKI FAMILY MEDICINE, P.C.

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	207Q00000X	Family Medicine Physician	045857	GA

General Provider Information

NPI Number	:	1487735056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOSOBUCKI FAMILY MEDICINE, P.C.

Provider Business Mailing Address
First Line	:	2008 WYNNTON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2407
Country	:	US
Telephone Number	:	706-321-9486
Fax Number	:	706-321-8891

Provider Business Practice Location Address
First Line	:	2008 WYNNTON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2407
Country	:	US
Telephone Number	:	706-321-9486
Fax Number	:	706-321-8891

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DANIEL E KOSOBUCKI
Credential	:
Telephone Number	:	706-321-9486

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	02/04/2014

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