Individual
MIMI S KOKOSKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4600 W LOOMIS RD, SUITE 201, GREENFIELD, WI 53220-4858
(414) 281-4466
Mailing address
4600 W LOOMIS RD, SUITE 201, GREENFIELD, WI 53220-4858
(414) 281-4466
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01054222A
IN
207Y00000X
Otolaryngology Physician
Primary
64145
WI
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
E-3850
AR
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
E-3850
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03120016300
QUALCHOICE
AR
05
—
150875001
—
AR
01
—
E3850
TRICARE
AR
01
—
P00082526
RAILROAD MEDICARE
AR
Enumeration date
09/27/2006
Last updated
07/30/2015
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