MEDICARE: KENNETH ALAN COGEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	M10054	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00704141	OTHER	ID	MCRR

General Provider Information

NPI Number	:	1629064555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH ALAN COGEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 587
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83303-0587
Country	:	US
Telephone Number	:	208-814-7400
Fax Number	:	208-814-7491

Provider Business Practice Location Address
First Line	:	746 N COLLEGE RD
Second Line	:	SUITE D
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-3486
Country	:	US
Telephone Number	:	208-814-7230
Fax Number	:	208-734-1178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	12/30/2014

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