Provider Demographics
NPI:1144297557
Name:KOSO, SYLVI KYLLIKKI (MD)
Entity type:Individual
Prefix:
First Name:SYLVI
Middle Name:KYLLIKKI
Last Name:KOSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 YAUGER ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9125
Mailing Address - Country:US
Mailing Address - Phone:740-397-2425
Mailing Address - Fax:740-392-1915
Practice Address - Street 1:1355 YAUGER ROAD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9125
Practice Address - Country:US
Practice Address - Phone:740-397-2425
Practice Address - Fax:740-392-1915
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046411207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0583659Medicaid
OH381073003OtherMEDICAL MUTUAL
OH4330726OtherAETNA
OH0800145OtherUNITED HEALTHCARE
000000117529OtherANTHEM BCBS
OHKO0552513Medicare PIN
C02800Medicare UPIN
OHKO0552314Medicare PIN