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Organization
KOSCIUSKO MEDICAL GROUP LLC
Active
Organization
KOSCIUSKO MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINA MUSIC (SR DIRECTOR PROVIDER ENROLLMENT)
(615) 465-7377
Entity
Organization
Contact information
Practice address
2235 DUBOIS DR, WARSAW, IN 46580-3212
(574) 267-8189
Mailing address
6920 POINTE INVERNESS WAY, SUITE 200, FORT WAYNE, IN 46804-7934
(260) 479-3513
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
NULL
174400000X
Specialist
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
NULL
207RH0003X
Hematology & Oncology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
02/23/2009
Last updated
10/01/2024
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