Healthcare Provider Details

I. General information

NPI: 1255379731
Provider Name (Legal Business Name): ERIK P KOHLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 SONORA CIR
EAGLE RIVER AK
99577-9403
US

IV. Provider business mailing address

8730 SONORA CIRCLE
EAGLE RIVER AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-982-0779
  • Fax:
Mailing address:
  • Phone: 907-982-0779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number5237
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: