Provider Demographics
NPI:1336287499
Name:KOSINA, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:KOSINA
Suffix:
Gender:M
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:PO BOX 651
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-0651
Mailing Address - Country:US
Mailing Address - Phone:605-842-1612
Mailing Address - Fax:605-842-3837
Practice Address - Street 1:825 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2688
Practice Address - Country:US
Practice Address - Phone:605-842-1612
Practice Address - Fax:605-842-3837
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2735208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE460381151-13Medicaid
SD24888OtherSANFORD HEALTH
SD2735OtherDAKOTACARE
0000662OtherWELLMARK BC/BS
SD7300360Medicaid
SD7300360Medicaid
NE460381151-13Medicaid
SD24888OtherSANFORD HEALTH