Provider Demographics
NPI:1033101886
Name:KOSIAK, JOHN A (MN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:KOSIAK
Suffix:
Gender:M
Credentials:MN
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Mailing Address - Street 1:7401 METRO BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3086
Mailing Address - Country:US
Mailing Address - Phone:952-920-4915
Mailing Address - Fax:952-915-6091
Practice Address - Street 1:11850 BLACKFOOT ST NW STE 150
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2583
Practice Address - Country:US
Practice Address - Phone:763-433-0221
Practice Address - Fax:763-433-0235
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2023-11-28
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Provider Licenses
StateLicense IDTaxonomies
MN278942085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN104840OtherUCARE
WI30572500Medicaid
MN856370500Medicaid
MN2400159OtherMEDICA
MN24601KOOtherBLUE CROSS/BLUE SHIELD
MNHP13729OtherHEALTH PARTNERS
MN25137OtherAMERICA'S PPO
MN963070250005OtherPREFERRED ONE
MN110020OtherCHOICE PLUS
MN2400004OtherMEDICA PRIMARY