Provider Demographics
NPI:1639562424
Name:KOSLOSKI, LOREN J
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:J
Last Name:KOSLOSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 TROOP DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4636
Mailing Address - Country:US
Mailing Address - Phone:320-237-1326
Mailing Address - Fax:
Practice Address - Street 1:2380 TROOP DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4636
Practice Address - Country:US
Practice Address - Phone:320-237-1326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program