Provider Demographics
NPI:1134715923
Name:KOSSENJANS, WILLIAM JOHN (PA-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:KOSSENJANS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 STATE ROUTE 28 UNIT F
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-4940
Mailing Address - Country:US
Mailing Address - Phone:513-981-4050
Mailing Address - Fax:513-322-4859
Practice Address - Street 1:1064 STATE ROUTE 28 UNIT F
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-4940
Practice Address - Country:US
Practice Address - Phone:513-981-4050
Practice Address - Fax:513-322-4859
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC995363A00000X
OH50.006569RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant