Provider Demographics
NPI:1306850532
Name:COSS, KEVIN C (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:COSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-4139
Mailing Address - Fax:317-621-7885
Practice Address - Street 1:8101 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4675
Practice Address - Country:US
Practice Address - Phone:317-621-5390
Practice Address - Fax:317-621-7885
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
IN01035162A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB29492Medicare UPIN
INM400037727Medicare PIN
IN214580CMedicare PIN