Healthcare Provider Details

I. General information

NPI: 1538103353
Provider Name (Legal Business Name): KAREN H KOGON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 W FAIRBANKS AVE
WINTER PARK FL
32789-4511
US

IV. Provider business mailing address

2600 WESTHALL LN
MAITLAND FL
32751-7102
US

V. Phone/Fax

Practice location:
  • Phone: 407-200-4776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number041580
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME151766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: