Individual
ANGELA MARIE KOGUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3535 S SMITH RD STE A, FAIRLAWN, OH 44333-9270
(330) 208-2720
(330) 208-2721
Mailing address
3801 SANTA ROSA DR, KINGMAN, AZ 86401-2311
(928) 757-2101
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2259532
—
OH
Enumeration date
11/20/2006
Last updated
11/19/2018
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