Provider Demographics
NPI:1396766291
Name:KOSKO, PAUL I (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:I
Last Name:KOSKO
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 1:1503 STRONG AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-4036
Mailing Address - Country:US
Mailing Address - Phone:662-453-1133
Mailing Address - Fax:662-455-9109
Practice Address - Street 1:1503 STRONG AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4036
Practice Address - Country:US
Practice Address - Phone:662-453-1133
Practice Address - Fax:662-455-9109
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS7328207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118920Medicaid
MS00118920Medicaid
MS182945396Medicare PIN