Provider Demographics
NPI:1740261825
Name:KENT I. KOSSOY
Entity type:Organization
Organization Name:KENT I. KOSSOY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIKLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-358-6761
Mailing Address - Street 1:22999 HIGHWAY 59 N
Mailing Address - Street 2:#188
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4438
Mailing Address - Country:US
Mailing Address - Phone:281-358-6761
Mailing Address - Fax:281-358-6742
Practice Address - Street 1:22999 HIGHWAY 59 N
Practice Address - Street 2:#188
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77339-4438
Practice Address - Country:US
Practice Address - Phone:281-358-6761
Practice Address - Fax:281-358-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00027ZMedicare ID - Type Unspecified