Healthcare Provider Details

I. General information

NPI: 1114981446
Provider Name (Legal Business Name): CHARLES ALLEN KOSOVE M.D., P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 N KROME AVE
HOMESTEAD FL
33030-3237
US

IV. Provider business mailing address

1851 N KROME AVE
HOMESTEAD FL
33030-3237
US

V. Phone/Fax

Practice location:
  • Phone: 305-246-0000
  • Fax: 305-245-1144
Mailing address:
  • Phone: 305-246-0000
  • Fax: 305-245-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberME22132
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME22123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: