MEDICARE: KENT I. KOSSOY

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	208C00000X	Colon & Rectal Surgery Physician

General Provider Information

NPI Number	:	1740261825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENT I. KOSSOY

Provider Business Mailing Address
First Line	:	22999 HIGHWAY 59 N
Second Line	:	#188
City	:	HUMBLE
State	:	TX
Zip	:	77339-4438
Country	:	US
Telephone Number	:	281-358-6761
Fax Number	:	281-358-6742

Provider Business Practice Location Address
First Line	:	22999 HIGHWAY 59 N
Second Line	:	#188
City	:	HUMBLE
State	:	TX
Zip	:	77339-4438
Country	:	US
Telephone Number	:	281-358-6761
Fax Number	:	281-358-6742

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	GENA SHIKLES
Credential	:
Telephone Number	:	281-358-6761

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/27/2009

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