MEDICARE: DR. DARRELL J KOHLI MD

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	207W00000X	Ophthalmology Physician	052758	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	180012681	OTHER	MI	RAILROAD MEDICARE

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
2	180B160140	OTHER	MI	BLUE CROSS BLUE SHIELD
3	1497792386	OTHER	MI	UP OPHTHALMOLOGY GR NPI

General Provider Information

NPI Number	:	1285633685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRELL J KOHLI MD

Provider Business Mailing Address
First Line	:	1015 S LINCOLN RD
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829-2100
Country	:	US
Telephone Number	:	906-474-6003
Fax Number	:	906-786-7403

Provider Business Practice Location Address
First Line	:	1015 S LINCOLN RD
Second Line	:
City	:	ESCANABA
State	:	MI
Zip	:	49829-2100
Country	:	US
Telephone Number	:	906-786-5181
Fax Number	:	906-786-7403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	06/22/2020

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