Provider Demographics
NPI:1356551691
Name:KOSEK, KEVIN (M D)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:KOSEK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BAPTIST DR STE 220
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-2031
Mailing Address - Country:US
Mailing Address - Phone:601-985-9120
Mailing Address - Fax:601-985-9122
Practice Address - Street 1:501 BAPTIST DR STE 220
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2031
Practice Address - Country:US
Practice Address - Phone:601-985-9120
Practice Address - Fax:601-985-9122
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-1953207W00000X
MS20492207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL123322OtherALABAMA MEDICAID
MSDN2775OtherMEDICARE RAILROAD-GROUP
MS08520364Medicaid
AL123322OtherALABAMA MEDICAID
MSDN2775OtherMEDICARE RAILROAD-GROUP