Provider Demographics
NPI:1518210004
Name:KOSAK, RUTH AIDA (DPM)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:AIDA
Last Name:KOSAK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:AIDA
Other - Last Name:KOSAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:11390 E VIA LINDA #102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259
Mailing Address - Country:US
Mailing Address - Phone:480-247-8443
Mailing Address - Fax:480-292-9381
Practice Address - Street 1:11390 E VIA LINDA #102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259
Practice Address - Country:US
Practice Address - Phone:480-247-8443
Practice Address - Fax:480-292-9381
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ798213ES0000X, 213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery