Provider Demographics
NPI:1497782239
Name:KOSAKOWSKI, CHRIS A (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:A
Last Name:KOSAKOWSKI
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 1:1111 SONOMA AVE
Mailing Address - Street 2:STE 112
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4813
Mailing Address - Country:US
Mailing Address - Phone:707-579-5520
Mailing Address - Fax:707-579-8820
Practice Address - Street 1:1111 SONOMA AVE
Practice Address - Street 2:STE 112
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4813
Practice Address - Country:US
Practice Address - Phone:707-579-5520
Practice Address - Fax:707-579-8820
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG4949902086S0127X
COG494990208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020052144OtherRAILROAD MEDICARE
CA00G494990OtherBS OF CALIFORNIA
CA00G494990Medicaid
CAA51383Medicare UPIN
CA00G494990Medicaid