Provider Demographics
NPI:1629052543
Name:KOSCIELSKI, MATTHEW FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:FRANCIS
Last Name:KOSCIELSKI
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 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 MEMORIAL DRIVE
Practice Address - Street 2:STE 512
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1075
Practice Address - Country:US
Practice Address - Phone:574-246-9350
Practice Address - Fax:574-246-9370
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038686A207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000321947OtherBLUE CROSS BLUE SHIELD
IN200039990Medicaid
INP00883981OtherRAILROAD MEDICARE
INP00083785OtherRAILROAD MEDICARE
INE42530Medicare UPIN
IN211770AMedicare PIN
IN941050OOOMedicare PIN