MEDICARE: MANISH 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	207RH0003X	Hematology & Oncology Physician	60238069	NY
2	207RX0202X	Medical Oncology Physician	103605	MN
3	207RX0202X	Medical Oncology Physician	50887	MN

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

General Provider Information

NPI Number	:	1407804040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANISH KOHLI MD

Provider Business Mailing Address
First Line	:	2000 CIRCLE OF HOPE DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5550
Country	:	US
Telephone Number	:	801-646-4018
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 CIRCLE OF HOPE DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5550
Country	:	US
Telephone Number	:	801-646-4018
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	11/03/2021

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Directions to “ MANISH KOHLI MD” Practice Location

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