Provider Demographics
NPI:1366599631
Name:KOS, MICHAEL F (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:KOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6506 S REGAL CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-2117
Mailing Address - Country:US
Mailing Address - Phone:775-560-5776
Mailing Address - Fax:530-576-0364
Practice Address - Street 1:13424 E MISSION AVE # A
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2759
Practice Address - Country:US
Practice Address - Phone:509-321-4980
Practice Address - Fax:530-576-0364
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV98932085R0001X
WAMD611575992085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016876Medicaid
NVG54991Medicare UPIN
NVV36205Medicare PIN