Provider Demographics
NPI:1881909174
Name:DR. ALAN S. KOSSOW, PA
Entity type:Organization
Organization Name:DR. ALAN S. KOSSOW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOSSOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-579-6400
Mailing Address - Street 1:145 LAMORAK LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5827
Mailing Address - Country:US
Mailing Address - Phone:407-579-6400
Mailing Address - Fax:
Practice Address - Street 1:255 N LAKEMONT AVE STE 202
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3219
Practice Address - Country:US
Practice Address - Phone:407-628-1665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D60623Medicare UPIN