Provider Demographics
NPI:1235368861
Name:KOSARAC, BRANKA (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANKA
Middle Name:
Last Name:KOSARAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 BROADWAY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7716
Mailing Address - Country:US
Mailing Address - Phone:281-485-4050
Mailing Address - Fax:
Practice Address - Street 1:8520 BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7716
Practice Address - Country:US
Practice Address - Phone:281-485-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10038538207Q00000X
TXP1342207Q00000X
VA0116021220390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304343202Medicaid
TX8EK655OtherBLUE CROSS BLUE SHIELD
TX8FT338OtherBLUE CROSS BLUE SHIELD
TX8FT338OtherBLUE CROSS BLUE SHIELD
TX371401YUD8Medicare PIN