Provider Demographics
NPI:1437119716
Name:KOSEK, GUNNAR F (DO)
Entity Type:Individual
Prefix:DR
First Name:GUNNAR
Middle Name:F
Last Name:KOSEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:134 W HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1727
Mailing Address - Country:US
Mailing Address - Phone:570-466-4150
Mailing Address - Fax:
Practice Address - Street 1:75 S. WYOMING AVE
Practice Address - Street 2:VALLEY MEDICAL SUITE 2 & 3
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-466-4150
Practice Address - Fax:210-539-2075
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS008851L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001640916Medicaid
G32764Medicare UPIN