Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | DK001920 | MI |
N | 213ES0103X | Foot & Ankle Surgery | DK001920 | MI |
NPI | 1467483727 |
---|---|
Provider Name | Daniel K Koschtial |
First Address | Wyoming, MI 49519-9606 |
Second Address | Comstock Park, MI 49321-9546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 05/12/2017 |