Provider Demographics
NPI:1144377938
Name:KOSKI, MICHELLE ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELAINE
Last Name:KOSKI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5893 COPLEY DR
Mailing Address - Street 2:KAISER GARFIELD DEPARTMENT OF UROLOGY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-7906
Mailing Address - Country:US
Mailing Address - Phone:888-694-7857
Mailing Address - Fax:760-510-5782
Practice Address - Street 1:5893 COPLEY DR
Practice Address - Street 2:KAISER GARFIELD DEPARTMENT OF UROLOGY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-7906
Practice Address - Country:US
Practice Address - Phone:888-694-7857
Practice Address - Fax:760-510-5782
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.203505208800000X
SC34108208800000X
CAA1256652088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA203505Medicaid