Provider Demographics
NPI:1205831054
Name:KOSKI, ROBERT G (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:KOSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0370
Mailing Address - Country:US
Mailing Address - Phone:906-265-4019
Mailing Address - Fax:
Practice Address - Street 1:1301 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-4725
Practice Address - Country:US
Practice Address - Phone:906-265-4019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008053207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4404930Medicaid
MI050B210034OtherBCBS OF MICHIGAN
OM31750014Medicare PIN
E31540Medicare UPIN