Provider Demographics
NPI:1821128265
Name:KOSCIUSKO FAMILY HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:KOSCIUSKO FAMILY HEALTHCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGALS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-267-8189
Mailing Address - Street 1:2235 DUBOIS DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3212
Mailing Address - Country:US
Mailing Address - Phone:574-267-8189
Mailing Address - Fax:574-267-7554
Practice Address - Street 1:2235 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3212
Practice Address - Country:US
Practice Address - Phone:574-267-8189
Practice Address - Fax:574-267-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN148550Medicare ID - Type Unspecified