MEDICARE: DR. MICHAEL E COGHLAN MD

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	171000000X	Military Health Care Provider	17128	AL
2	207RI0200X	Infectious Disease Physician	17128	AL
3	2083A0100X	Aerospace Medicine Physician	17128	AL

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

General Provider Information

NPI Number	:	1649209180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E COGHLAN MD

Provider Business Mailing Address
First Line	:	14TH MEDICAL GROUP 201 INDEPENDENCE DRIVE
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39710-0001
Country	:	US
Telephone Number	:	662-434-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	COLUMBUS AFB 14TH MEDICAL GROUP 201 INDEPENDENCE DRIVE
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39710-0001
Country	:	US
Telephone Number	:	662-434-2273
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	03/27/2024

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