Provider Demographics
NPI:1609954643
Name:COSSU, JOHN L (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:COSSU
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:7050 WINKLER RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-985-9518
Mailing Address - Fax:239-985-9546
Practice Address - Street 1:7050 WINKLER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919
Practice Address - Country:US
Practice Address - Phone:239-985-9518
Practice Address - Fax:239-985-9546
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS004646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82674ZMedicare PIN
FL1356538052Medicare NSC
FL39472Medicare PIN
FLD60698Medicare UPIN
FL1609954643Medicare NSC