Provider Demographics
NPI:1073520474
Name:ADAMS, DIANE KOSICH (DO)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KOSICH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:K
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:10355 E ILIFF AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80247-3622
Mailing Address - Country:US
Mailing Address - Phone:303-755-4955
Mailing Address - Fax:303-755-4956
Practice Address - Street 1:10355 E ILIFF AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80247-3622
Practice Address - Country:US
Practice Address - Phone:303-755-4955
Practice Address - Fax:303-755-4956
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11438207R00000X
CODR.0045080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G46592Medicare UPIN
VN2651Medicare ID - Type Unspecified