Individual
DR. SUDJONO KOSIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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