Provider Demographics
NPI:1659788685
Name:KOSHAK, CHRISTINA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNN
Last Name:KOSHAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LYNN
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3530 E SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2209
Mailing Address - Country:US
Mailing Address - Phone:719-296-9000
Mailing Address - Fax:719-296-9001
Practice Address - Street 1:3530 E SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2209
Practice Address - Country:US
Practice Address - Phone:719-296-9000
Practice Address - Fax:719-296-9001
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014021822207X00000X
CO63364207XS0117X
CODR.0063364207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine