Organization
MICHAEL R. COSENZA, DPM, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLIE HAWKINS (CREDENTIALING ACCOUNT MANAGER)
(210) 298-6847
Entity
Organization
Contact information
Practice address
238 HOSPITAL DR STE B, UKIAH, CA 95482-4559
(707) 463-3668
(707) 463-3664
Mailing address
238 HOSPITAL DR STE B, UKIAH, CA 95482-4559
(707) 463-3668
(707) 463-3664
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
E4380
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000E43800
MEDICARE
CA
Enumeration date
10/25/2017
Last updated
10/25/2017
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