MEDICARE: KELLY ANN KOGUT M.D., P.C.

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	2086S0120X	Pediatric Surgery Physician	9338	NV

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	:	1881694719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ANN KOGUT M.D., P.C.

Provider Business Mailing Address
First Line	:	653 N TOWN CENTER DR
Second Line	:	SUITE 507
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0514
Country	:	US
Telephone Number	:	702-233-8101
Fax Number	:	702-242-0726

Provider Business Practice Location Address
First Line	:	653 N TOWN CENTER DR
Second Line	:	SUITE 507
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-0514
Country	:	US
Telephone Number	:	702-233-8101
Fax Number	:	702-242-0726

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	01/15/2008

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