Provider Demographics
NPI:1780731414
Name:KOSIOREK, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:KOSIOREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2451 E BASELINE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2471
Mailing Address - Country:US
Mailing Address - Phone:480-507-2199
Mailing Address - Fax:480-507-0677
Practice Address - Street 1:2451 E BASELINE RD
Practice Address - Street 2:STE 200
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2471
Practice Address - Country:US
Practice Address - Phone:480-507-2199
Practice Address - Fax:480-507-0677
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ20136208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ053504Medicaid
AZAZ0889880OtherBLUE CROSS BLUE SHEILD
AZ2048349OtherAETNA US HEALTHCARE
AZ1Z5874OtherHEALTHNET