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Organization
SUSAN KOSLOW M.D.,INC
Active
Organization
SUSAN KOSLOW M.D.,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRIS DOAN (BILLING SUPERVISOR)
(812) 234-4243
Entity
Organization
Contact information
Practice address
477 E TRAILWOOD DR, TERRE HAUTE, IN 47802-9606
(812) 234-4243
(812) 478-3663
Mailing address
PO BOX 10037, TERRE HAUTE, IN 47801-0037
(812) 234-4243
(812) 478-3663
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
01042883A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100462130A
—
IN
01
—
M100067995
MEDICARE PTAN
IN
Enumeration date
02/15/2012
Last updated
12/18/2014
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