Individual
DR. BRIAN R KOSOBUCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3333 BROOKVIEW HILLS BLVD, SUITE 107, WINSTON SALEM, NC 27103-5661
(336) 842-3780
(336) 842-3964
Mailing address
3333 BROOKVIEW HILLS BLVD STE 107, WINSTON SALEM, NC 27103-5661
(336) 970-5900
(336) 842-3964
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
200401088
NC
207WX0107X
Retina Specialist (Ophthalmology) Physician
200401088
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137HT
BCBS
NC
05
—
1689048423
—
NC
01
—
804621
PARTNERS
NC
01
—
NCR000F360
MEDICARE PTAN
—
Enumeration date
09/16/2006
Last updated
01/15/2024
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