Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 798 | AZ |
N | 2081S0010X | Sports Medicine | 798 | AZ |
N | 213ES0000X | Sports Medicine | 798 | AZ |
N | 213ES0103X | Foot & Ankle Surgery | 798 | AZ |
NPI | 1518210004 |
---|---|
Provider Name | Dr. Ruth Aida Kosak |
First Address | Scottsdale, AZ 85259 |
Second Address | Scottsdale, AZ 85259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2012 |
Last Update Date | 14/08/2017 |