Provider Demographics
NPI:1477765832
Name:KOSAL, LINDA LU REESE (DO)
Entity Type:Individual
Prefix:
First Name:LINDA LU
Middle Name:REESE
Last Name:KOSAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LINDA LU
Other - Middle Name:REESE
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:15520 19 MILE ROAD
Mailing Address - Street 2:SUITE 480
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6332
Mailing Address - Country:US
Mailing Address - Phone:586-228-1010
Mailing Address - Fax:586-228-8570
Practice Address - Street 1:15520 19 MILE RD
Practice Address - Street 2:SUITE 480
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6333
Practice Address - Country:US
Practice Address - Phone:586-228-1010
Practice Address - Fax:586-228-1010
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E07884012Medicare PIN