Provider Demographics
NPI:1326138009
Name:KOSNETT, MICHAEL J (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:KOSNETT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4495 HALE PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6204
Mailing Address - Country:US
Mailing Address - Phone:303-571-5778
Mailing Address - Fax:877-554-1121
Practice Address - Street 1:4495 HALE PKWY STE 301
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-6204
Practice Address - Country:US
Practice Address - Phone:303-571-5778
Practice Address - Fax:877-554-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34063207R00000X, 207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01340637Medicaid
CO01340637Medicaid