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General NPI Number Information
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NPI Number | 1083147102
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Entity Type | Individual
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Provider Name | AMY COGAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 10590 N MERIDIAN ST STE 105
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City | CARMEL
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State | IN
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Zip | 46290-1028
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Country | US
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Telephone | 317-583-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 12251 S 80TH AVE STE 1520
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1290
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Country | US
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Telephone | 708-923-4200
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Fax | 708-923-4201
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.005054RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9117662
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 10004787A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085008955
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License Number State | IL
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