Provider Demographics
NPI:1386717593
Name:KOSINSKI, FREDERICK AUGUSTUS (PHD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:AUGUSTUS
Last Name:KOSINSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9045 US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1804
Mailing Address - Country:US
Mailing Address - Phone:269-473-2222
Mailing Address - Fax:269-473-6880
Practice Address - Street 1:9045 US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1633
Practice Address - Country:US
Practice Address - Phone:269-473-2222
Practice Address - Fax:269-473-6880
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005994103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902086689OtherGROUP NPI
MI680A112130OtherBLUE CROSS GROUP PIN
MI0A14512Medicare ID - Type Unspecified