Individual
PHILIP KODSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
22101 MOROSS RD, DETROIT, MI 48236
(313) 343-4000
Mailing address
55226 NILE WAY, MACOMB, MI 48042-6194
(586) 883-4949
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704307415
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704307415
MI
Other
Enumeration date
07/23/2018
Last updated
09/04/2018
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