Provider Demographics
NPI:1205865037
Name:KOGOS, PHILIP G (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:G
Last Name:KOGOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE N-108
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3151
Mailing Address - Country:US
Mailing Address - Phone:504-349-1461
Mailing Address - Fax:504-349-1470
Practice Address - Street 1:1101 MEDICAL CENTER BLVD
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3147
Practice Address - Country:US
Practice Address - Phone:504-349-1461
Practice Address - Fax:504-349-1470
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL287632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC287638Medicaid
MS03930313Medicaid
LA1197378Medicaid
LA4N237Medicare PIN
SCI54582Medicare UPIN
LA1197378Medicaid
SCAA1381Medicare PIN