Provider Demographics
NPI:1710980545
Name:KOSMOSKI, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:KOSMOSKI
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 1:431 E STATE HIGHWAY 114
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4412
Mailing Address - Country:US
Mailing Address - Phone:817-510-5000
Mailing Address - Fax:817-510-5001
Practice Address - Street 1:431 E STATE HIGHWAY 114
Practice Address - Street 2:SUITE 450
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4412
Practice Address - Country:US
Practice Address - Phone:817-310-9320
Practice Address - Fax:817-416-2800
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE92906Medicare UPIN
TX8M7150Medicare ID - Type Unspecified