Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301098041 | MI |
N | 208000000X | Pediatrician | ML20009004 | WA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 4301098041 | MI |
NPI | 1033301411 |
---|---|
Provider Name | Carl J Koschmann |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 07/11/2019 |