Provider Demographics
NPI:1487688339
Name:COBANOGLU, MUSTAFA ADNAN (MD)
Entity type:Individual
Prefix:
First Name:MUSTAFA
Middle Name:ADNAN
Last Name:COBANOGLU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOMA LINDA UNIVERSITY
Mailing Address - Street 2:11175 CAMPUS STREET SUITE 21123
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2741
Mailing Address - Country:US
Mailing Address - Phone:909-558-4354
Mailing Address - Fax:
Practice Address - Street 1:LOMA LINDA UNIVERSITY
Practice Address - Street 2:11175 CAMPUS STREET SUITE 21123
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2741
Practice Address - Country:US
Practice Address - Phone:909-558-4354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087458208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000221079OtherUNISON
000000503670OtherANTHEM
OH2638793Medicaid
741756OtherBUCKEYE
363430OtherWELLCARE
7818813OtherAETNA
OHCO4181331Medicare PIN
741756OtherBUCKEYE
000000221079OtherUNISON