Provider Demographics
NPI:1679550925
Name:KOSSOW, ALAN S (DO)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:KOSSOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:145 LAMORAK LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5827
Mailing Address - Country:US
Mailing Address - Phone:407-628-8041
Mailing Address - Fax:407-628-8041
Practice Address - Street 1:255 N LAKEMONT AVE SUITE 202
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-628-1665
Practice Address - Fax:407-629-6461
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2016-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLS0003916208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065963100Medicaid
FL82365Medicare ID - Type Unspecified
D60623Medicare UPIN
FL065963100Medicaid