Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 29368 | AZ |
NPI | 1053365742 |
---|---|
Provider Name | Michael V Koss |
First Address | Peoria, AZ 85381-4846 |
Second Address | Sun City West, AZ 85375-5284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
569345 | (05) | AZ |
H39866 | (02) | AZ |