Provider Demographics
NPI:1114981446
Name:KOSOVE, CHARLES ALLEN (MD, PA)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALLEN
Last Name:KOSOVE
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3237
Mailing Address - Country:US
Mailing Address - Phone:305-246-0000
Mailing Address - Fax:305-245-1144
Practice Address - Street 1:1851 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3237
Practice Address - Country:US
Practice Address - Phone:305-246-0000
Practice Address - Fax:305-245-1144
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22132207YX0602X
FLME22123207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037036300Medicaid
FL53488YMedicare PIN
FLD56547Medicare UPIN