Basic Information
| Provider Information | |||||||||
| NPI: | 1386717593 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOSINSKI | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | AUGUSTUS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9045 US HIGHWAY 31 | ||||||||
| Address2: | |||||||||
| City: | BERRIEN SPRINGS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491031804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694732222 | ||||||||
| FaxNumber: | 2694736880 | ||||||||
| Practice Location | |||||||||
| Address1: | 9045 US HIGHWAY 31 | ||||||||
| Address2: | |||||||||
| City: | BERRIEN SPRINGS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 491031633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694732222 | ||||||||
| FaxNumber: | 2694736880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 10/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301005994 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 1902086689 | 01 | MI | GROUP NPI | OTHER | 680A112130 | 01 | MI | BLUE CROSS GROUP PIN | OTHER |