Provider Demographics
NPI:1811066848
Name:COSENS, BRENT LEROY (DO)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:LEROY
Last Name:COSENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 E CENTENNIAL DR
Mailing Address - Street 2:SUITE 3 & 4
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6559
Mailing Address - Country:US
Mailing Address - Phone:620-231-8003
Mailing Address - Fax:620-231-8502
Practice Address - Street 1:200 E CENTENNIAL DR
Practice Address - Street 2:SUITE 3 & 4
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6559
Practice Address - Country:US
Practice Address - Phone:620-231-8003
Practice Address - Fax:620-231-8502
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100231300BMedicaid
KS100231300BMedicaid
KS104591Medicare ID - Type Unspecified