Provider Demographics
NPI:1376071431
Name:KOSELKE, ASHLEY STOBAUGH (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:STOBAUGH
Last Name:KOSELKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:315 N DAN JONES RD STE 150
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2848
Practice Address - Country:US
Practice Address - Phone:317-781-7328
Practice Address - Fax:317-781-7216
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2023-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01081637A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine