Individual
MR. KOSSI MAWOULI ZOTOGLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4101 WOOLWORTH AVE, OMAHA, NE 68105-1850
(402) 995-3462
Mailing address
3254 S 72ND AVE, OMAHA, NE 68124-3576
(402) 681-1036
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
090410
IA
Other
Enumeration date
01/09/2018
Last updated
12/15/2023
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