Provider Demographics
NPI:1639243678
Name:KOSAREK, CHERYL A (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:KOSAREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 DAVIS LN STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4061
Mailing Address - Country:US
Mailing Address - Phone:512-615-2730
Mailing Address - Fax:512-666-3764
Practice Address - Street 1:5301 DAVIS LN STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4061
Practice Address - Country:US
Practice Address - Phone:512-615-2730
Practice Address - Fax:512-572-5183
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0557207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA83010Medicare UPIN
TX00J45ZMedicare ID - Type Unspecified