Provider Demographics
NPI:1144667429
Name:COSHIRE MEDICAL GROUP INC
Entity type:Organization
Organization Name:COSHIRE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LILJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-4959
Mailing Address - Street 1:555 KNOWLES DR
Mailing Address - Street 2:STE 203
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1549
Mailing Address - Country:US
Mailing Address - Phone:408-356-4959
Mailing Address - Fax:405-358-8692
Practice Address - Street 1:555 KNOWLES DR
Practice Address - Street 2:STE 203
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1549
Practice Address - Country:US
Practice Address - Phone:408-356-4959
Practice Address - Fax:405-358-8692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty