Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME22123 | FL |
NPI | 1114981446 |
---|---|
Provider Name | Dr. Charles Allen Kosove |
First Address | Homestead, FL 33030-3237 |
Second Address | Homestead, FL 33030-3237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 20/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
037036300 | (05) | FL |
D56547 | (02) | FL |