03D0979127 CLIA NUMBER - THOMAS KOTOSKE DO OF THE COSMETIC SURGERY INSTITUTE LTD

Laboratory Demographics

CLIA Number: 03D0979127

Facility Name: THOMAS KOTOSKE DO OF THE COSMETIC SURGERY INSTITUTE LTD

Facility Address:
19636 N 27TH AVE, #101
PHOENIX, AZ
ZIP 85027
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Facility Phone Number: 623 516-2639

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1861571960

Taxonomy: 207YX0905X - Otolaryngology
An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions.

CLIA Record

Field Name	Field Value
CLIA Number	03D0979127
LAB Type	Physician Office
Facility Name	THOMAS KOTOSKE DO OF THE COSMETIC SURGERY INSTITUTE LTD
Street	19636 N 27TH AVE, #101
City	PHOENIX
State	AZ
ZIP	85027
Phone	623 516-2639
CertificateType	4
CertificateEffectiveDate	10/13/2022
CertificateExpirationDate	10/12/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024