Provider Demographics
NPI:1811196280
Name:JAMES R. KOSIUR, D.O., P.C.
Entity Type:Organization
Organization Name:JAMES R. KOSIUR, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOSIUR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-281-2773
Mailing Address - Street 1:2591 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9094
Mailing Address - Country:US
Mailing Address - Phone:616-281-2773
Mailing Address - Fax:616-281-2836
Practice Address - Street 1:2591 44TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-9094
Practice Address - Country:US
Practice Address - Phone:616-281-2773
Practice Address - Fax:616-281-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011746207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3417943Medicaid
MI2054101570OtherBCBS
MI0M54990Medicare PIN
MIF98041Medicare UPIN