MEDICARE: ANTHONY T. KOSOGLOV, INC.

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	207R00000X	Internal Medicine Physician	35057981	OH

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	:	1861598724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY T. KOSOGLOV, INC.

Provider Business Mailing Address
First Line	:	99 NORTHLINE CIR
Second Line	:	SUITE 215
City	:	EUCLID
State	:	OH
Zip	:	44119-1482
Country	:	US
Telephone Number	:	216-692-7600
Fax Number	:	216-692-7606

Provider Business Practice Location Address
First Line	:	99 NORTHLINE CIR
Second Line	:	SUITE 215
City	:	EUCLID
State	:	OH
Zip	:	44119-1482
Country	:	US
Telephone Number	:	216-692-7600
Fax Number	:	216-692-7606

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY THOMAS KOSOGLOV
Credential	:	MD
Telephone Number	:	216-692-7600

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	02/05/2008

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