Provider Demographics
NPI:1750300679
Name:KOSS, MARCUS E (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:E
Last Name:KOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:21603 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1636
Mailing Address - Country:US
Mailing Address - Phone:586-280-2100
Mailing Address - Fax:833-496-1920
Practice Address - Street 1:21603 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1636
Practice Address - Country:US
Practice Address - Phone:586-280-2100
Practice Address - Fax:586-210-8808
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI135327OtherPREFERRED CHOICES
MICB2510OtherRAILROAD MEDICARE
MIOH24993OtherBLUE CROSS AND BLUE SHIELD OF MICHIGAN
MICB2510OtherRAILROAD MEDICARE
MICB2510OtherRAILROAD MEDICARE