Individual
DR. JOHN KENNETH KOSIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
HCR 61 BOX 30, JCT US HWY 160 & NR 35 - RED MESA, TEEC NOS POS, AZ 86514
(928) 656-5000
(928) 656-5164
Mailing address
HCR 61 BOX 30, JCT US HWY 160 & NR 35 - RED MESA, TEEC NOS POS, AZ 86514
(928) 656-5000
(928) 656-5164
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5766873-1204
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260813
—
AZ
05
—
36250767
—
NM
05
—
40584054
—
CO
Enumeration date
11/08/2006
Last updated
04/19/2012
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