Provider Demographics
NPI:1891760286
Name:KOSIUR, JAMES RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:KOSIUR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1009
Mailing Address - Country:US
Mailing Address - Phone:810-648-6113
Mailing Address - Fax:810-648-0262
Practice Address - Street 1:100 W. ARGYLE STREET
Practice Address - Street 2:SANILAC MEDICAL PLAZA
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471
Practice Address - Country:US
Practice Address - Phone:810-648-6113
Practice Address - Fax:810-648-0262
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011746207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI341794311Medicaid
MI0M54990Medicare ID - Type Unspecified
MI341794311Medicaid