Provider Demographics
NPI:1427004464
Name:KOSLOW, ALAN RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RUSSELL
Last Name:KOSLOW
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 1:974 73RD ST
Mailing Address - Street 2:SUITE 23
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1024
Mailing Address - Country:US
Mailing Address - Phone:515-284-1976
Mailing Address - Fax:515-223-3010
Practice Address - Street 1:974 73RD ST
Practice Address - Street 2:SUITE 23
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1024
Practice Address - Country:US
Practice Address - Phone:515-284-1976
Practice Address - Fax:515-223-3010
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA303902086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2119164Medicaid
IA38296OtherBLUE CROSS & BLUE SHIELD
IA2119164Medicaid
IAI15066Medicare ID - Type Unspecified