Provider Demographics
NPI:1356886311
Name:KOSKINIEMI, MIKE (PHD)
Entity type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:KOSKINIEMI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-1833
Mailing Address - Country:US
Mailing Address - Phone:906-361-8585
Mailing Address - Fax:906-228-8330
Practice Address - Street 1:910 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-1833
Practice Address - Country:US
Practice Address - Phone:906-361-8585
Practice Address - Fax:906-228-8330
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704116756163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse