MEDICARE: DR. KATHLEEN GAIL KOHUT D.O.

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	207R00000X	Internal Medicine Physician	171096	NY

General Provider Information

NPI Number	:	1467519900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN GAIL KOHUT D.O.

Provider Business Mailing Address
First Line	:	10152 LEFFERTS BLVD
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2006
Country	:	US
Telephone Number	:	718-849-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	10152 LEFFERTS BLVD
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2006
Country	:	US
Telephone Number	:	718-849-0404
Fax Number	:

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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