Provider Demographics
NPI:1437155561
Name:KOSHY, BETTY (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:
Last Name:KOSHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-3703
Mailing Address - Country:US
Mailing Address - Phone:269-985-0029
Mailing Address - Fax:269-985-0040
Practice Address - Street 1:820 LESTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2561
Practice Address - Country:US
Practice Address - Phone:269-985-0029
Practice Address - Fax:269-985-0040
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032733207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4647527Medicaid
MI11-0111404-1OtherBCBS
MI36-30032OtherPHYSICIANS HEALTH PLAN
MIN67740004Medicare ID - Type Unspecified
MI11-0111404-1OtherBCBS