MEDICARE: MARCUS E KOSS M.D.

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	4301074604	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CB2510	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	135327	OTHER	MI	PREFERRED CHOICES
3	OH24993	OTHER	MI	BLUE CROSS AND BLUE SHIELD OF MICHIGAN

General Provider Information

NPI Number	:	1750300679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS E KOSS M.D.

Provider Business Mailing Address
First Line	:	21603 E 11 MILE RD
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1636
Country	:	US
Telephone Number	:	586-280-2100
Fax Number	:	833-496-1920

Provider Business Practice Location Address
First Line	:	21603 E 11 MILE RD
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1636
Country	:	US
Telephone Number	:	586-280-2100
Fax Number	:	586-210-8808

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	04/14/2022

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Directions to “ MARCUS E KOSS M.D.” Practice Location

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