Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 61623 | WI |
NPI | 1073872032 |
---|---|
Provider Name | Dr. Ian Joseph Koszewski |
First Address | Madison, WI 53792-0001 |
Second Address | Madison, WI 53792-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 11/01/2021 |