Individual
DR. SUDJONO KOSIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
718 N. MACOMB, MONROE, MI 48161
(734) 240-8400
Mailing address
718 N. MACOMB, MONROE, MI 48161
(734) 240-8400
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301040246
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12915
COMMUNITY CHOICE OF MI
MI
05
—
3442490
—
MI
01
—
3442516
HEALTH PLAN OF MI
MI
01
—
38338429803
CNA HEALTH SERVICES
MI
01
—
802982
COMMUNITY CARE PLAN
MI
Enumeration date
10/03/2006
Last updated
07/08/2007
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