Provider Demographics
NPI:1689636490
Name:KOSANOVICH, RODNEY M (DPM)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:M
Last Name:KOSANOVICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5676 STEUBENVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1437
Mailing Address - Country:US
Mailing Address - Phone:412-787-1276
Mailing Address - Fax:412-787-7756
Practice Address - Street 1:5676 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1437
Practice Address - Country:US
Practice Address - Phone:412-787-1276
Practice Address - Fax:412-787-7756
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002457L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009271200004Medicaid
PA0009271200004Medicaid
PA004926Medicare PIN