Provider Demographics
NPI:1609889815
Name:COGAN, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:COGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:780 ATLANTIC AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4565
Mailing Address - Country:US
Mailing Address - Phone:562-989-5722
Mailing Address - Fax:562-989-5732
Practice Address - Street 1:780 ATLANTIC AVE FL 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813
Practice Address - Country:US
Practice Address - Phone:562-989-5722
Practice Address - Fax:562-989-5732
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA679460208D00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A679460Medicaid
05D0554276OtherCLIA #
CA1134132343Medicaid
CA1134132343Medicaid
CA00A679460Medicaid
BC6270235OtherDEA
CAWA67946CMedicare PIN