Provider Demographics
NPI:1861598724
Name:ANTHONY T. KOSOGLOV, INC.
Entity type:Organization
Organization Name:ANTHONY T. KOSOGLOV, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KOSOGLOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-692-7600
Mailing Address - Street 1:99 NORTHLINE CIR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1482
Mailing Address - Country:US
Mailing Address - Phone:216-692-7600
Mailing Address - Fax:216-692-7606
Practice Address - Street 1:99 NORTHLINE CIR
Practice Address - Street 2:SUITE 215
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1482
Practice Address - Country:US
Practice Address - Phone:216-692-7600
Practice Address - Fax:216-692-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2718563Medicaid
OH9308401Medicare PIN
OHCG8574Medicare PIN