Provider Demographics
NPI:1568647691
Name:MICHAEL KOS, MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL KOS, MD A PROFESSIONAL CORPORATION
Other - Org Name:NORTHERN NEVADA RADIATION ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CATTANEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-955-5983
Mailing Address - Street 1:6506 S REGAL CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-2117
Mailing Address - Country:US
Mailing Address - Phone:530-955-5983
Mailing Address - Fax:530-576-0364
Practice Address - Street 1:6506 S REGAL CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-2117
Practice Address - Country:US
Practice Address - Phone:530-955-5983
Practice Address - Fax:530-576-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV98932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016876Medicaid
NVV36205Medicare PIN