Provider Demographics
NPI:1326033663
Name:KOGUT, DENNIS W (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
Last Name:KOGUT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 RENAISSANCE PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4709
Mailing Address - Country:US
Mailing Address - Phone:419-882-5678
Mailing Address - Fax:419-882-7446
Practice Address - Street 1:5965 RENAISSANCE PL
Practice Address - Street 2:SUITE 1
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4709
Practice Address - Country:US
Practice Address - Phone:419-882-5678
Practice Address - Fax:419-882-7446
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2662103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKOCP2553Medicare ID - Type Unspecified