DR. SUDJONO KOSIM (NPI# 1780779330) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780779330 |
| Entity Type | Individual |
| Full Name | DR. SUDJONO KOSIM |
| Other Name | HONG T JAY SIM |
| Credential | MD |
| Practice Address |
718 N. Macomb Monroe MI 48161 |
| Practice Telephone | 7342408400 |
| Mailing Telephone | 7342408400 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
4301040246 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | HEALTH PLAN OF MI | 3442516 | 01 |
| MI | CNA HEALTH SERVICES | 38338429803 | 01 |
| MI | COMMUNITY CARE PLAN | 802982 | 01 |
| MI | 3442490 | 05 | |
| MI | COMMUNITY CHOICE OF MI | 12915 | 01 |
| MI | MOLINA HEALTHCARE | 3442516 | 01 |
| Street Address |
718 N. MACOMB |
| City | MONROE |
| State | MI |
| Zip Code | 48161 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437242070 | Craig Shepherd Smith | Radiology | 718 N. Macomb, Monroe, MI 48161 | 2006-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164980967 | James Abrams | Behavior Technician | 2086 South Custer Road, Monroe, MI 48161 | 2019-03-11 |
| 1457841504 | Teresa Anne Clark-jones | Health Educator | Msu Extension Monroe County, 963 S. Raisinville Rd., Monroe, MI 48161 | 2018-05-15 |
| 1174045215 | Ariane E Combs | Counselor | 25 S. Monroe Street, Suite 205, Monroe, MI 48161 | 2017-07-11 |
| 1518341650 | Jennifer Statler | Physical Therapist | 1380 Lake Dr, Unit B, Monroe, MI 48161 | 2015-07-18 |
| 1811376742 | Rainbow Center of Michigan, Inc | Community/Behavioral Health | 14733 S. Telegraph Rd, Monroe, MI 48161 | 2015-05-26 |
| 1356743371 | Samantha Rose Dehring | Counselor | Recovery Zone Counseling, Pllc, 49 South Monroe St. (suite# 175), Monroe, MI 48161 | 2014-09-22 |
| 1598105074 | Busharat Ahmad | Ophthalmology | 774 Windsor Court, Monroe, MI 48161 | 2013-06-28 |
| 1225371032 | Anissa Castelluzzo | Nurse Practitioner | 975 S Monroe St Ste C, Monroe, MI 48161 | 2013-03-29 |
| 1811256274 | Paul Mikels Lmsw LLC | Social Worker | 986 S. Telegraph Rd, Monroe, MI 48161 | 2012-05-04 |
| 1225306798 | Paula Stanifer | Counselor | 14930 Laplaisance Rd #123, Monroe, MI 48161 | 2011-12-12 |
| Find all providers in zip 48161 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194068460 | David Soroush Gorovoy | Radiology | 178 Pine Tree Rd, Monroe, NY 10950-3964 | 2013-04-04 |
| 1659529469 | Michael Barnidge Jr. | Radiology | 1888 Hudson Cir Ste 2, Monroe, LA 71201 | 2008-09-04 |
| 1407003510 | Presbyterian Imaging Centers LLC | Radiology | 2000 Wellness Boulevard, Ste 110, Monroe, NC 28110-7764 | 2008-08-20 |
| 1538376116 | Alan Herschman | Radiology | 4 Winnie Palmer Ct, Monroe, NJ 08831-8833 | 2007-05-16 |
| 1437242070 | Craig Shepherd Smith | Radiology | 718 N. Macomb, Monroe, MI 48161 | 2006-10-02 |
| 1043227887 | Lovick Pierce Thomas Vi | Radiology | 1601 Lamy Lane, Monroe, LA 71201 | 2006-08-02 |
| 1891721429 | Anne Dopson Halsell | Radiology | 1888 Hudson Cir, Ste 2, Monroe, LA 71201-3546 | 2006-06-24 |
| 1528094455 | Brenton Wayne Mcdonald | Radiology | 2807 Evangeline St, Monroe, LA 71201-3749 | 2006-06-23 |
| 1649216151 | Lin Xiong | Radiology | 1601 Lamy Ln, Monroe, LA 71201-3735 | 2006-06-22 |
| 1962450155 | Mecklenburg Diagnostic Imaging LLC | Radiology | 1309 E Sunset Dr, Monroe, NC 28112-4324 | 2006-05-04 |
| Find all providers in MONROE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.