Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 01054222A | IN |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 64145 | WI |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | E-3850 | AR |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | E-3850 | AR |
NPI | 1770674897 |
---|---|
Provider Name | Mimi S Kokoska |
First Address | Greenfield, WI 53220-4858 |
Second Address | Greenfield, WI 53220-4858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 30/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03120016300 | QUALCHOICE (01) | AR |
150875001 | (05) | AR |
E3850 | TRICARE (01) | AR |
F48248 | (02) | |
P00082526 | RAILROAD MEDICARE (01) | AR |