Provider Demographics
NPI:1972066348
Name:STOKOSA, JAN J (CP, FAAOP)
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:J
Last Name:STOKOSA
Suffix:
Gender:M
Credentials:CP, FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2145 UNIVERSITY PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864
Mailing Address - Country:US
Mailing Address - Phone:517-349-3130
Mailing Address - Fax:517-349-8887
Practice Address - Street 1:2145 UNIVERSITY PARK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864
Practice Address - Country:US
Practice Address - Phone:517-349-3130
Practice Address - Fax:517-349-8887
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier