MEDICARE: TAMEIRA L. KOSTERS

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	363A00000X	Physician Assistant	5601013099	MI

General Provider Information

NPI Number	:	1780460998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMEIRA L. KOSTERS

Provider Business Mailing Address
First Line	:	3950 HOLLYWOOD RD STE 270
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-9158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 HOLLYWOOD RD STE 270
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-9158
Country	:	US
Telephone Number	:	269-983-0500
Fax Number	:

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

Provider Enumeration Date	:	09/04/2023
Last Update Date	:	03/20/2026

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Directions to “ TAMEIRA L. KOSTERS ” Practice Location

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