Basic Information
| Provider Information | |||||||||
| NPI: | 1104820927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOSAR | ||||||||
| FirstName: | EROL | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2481 LOMITA BLVD. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905055116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102570508 | ||||||||
| FaxNumber: | 3103258109 | ||||||||
| Practice Location | |||||||||
| Address1: | 2841 LOMITA BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905055116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102570508 | ||||||||
| FaxNumber: | 3103258109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 03/09/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/15/2006 | ||||||||
| NPIReactivationDate: | 03/23/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | G75877 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 00G758770 | 05 | CA | MEDICAID | WG75877E | 01 | CA | MEDICARE ID | OTHER |