Individual
DR. MELISSA JO KOKOSZKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
222 E PRIMROSE ST, SUITE E, SPRINGFIELD, MO 65807-5206
(417) 888-0167
(417) 888-0189
Mailing address
222 E PRIMROSE ST, SUITE E, SPRINGFIELD, MO 65807-5206
(417) 888-0167
(417) 888-0189
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2009009429
MO
207L00000X
Anesthesiology Physician
D0066112
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396958260
—
MO
05
—
180693001
—
AR
05
—
413312900
—
MD
01
—
431560263
TRICARE WEST
—
01
—
P00760866
RAILROAD MEDICARE
—
Enumeration date
05/08/2007
Last updated
04/23/2016
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