Provider Demographics
NPI:1336460195
Name:CHARLES A. KOSOVE, MD, PA.
Entity Type:Organization
Organization Name:CHARLES A. KOSOVE, MD, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MERRI
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-246-0000
Mailing Address - Street 1:1851 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3237
Mailing Address - Country:US
Mailing Address - Phone:305-246-0000
Mailing Address - Fax:305-245-1144
Practice Address - Street 1:1851 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3237
Practice Address - Country:US
Practice Address - Phone:305-246-0000
Practice Address - Fax:305-245-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22123207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037036300Medicaid
FL037036300Medicaid
FLEV817AMedicare PIN