Healthcare Provider Details

I. General information

NPI: 1518924711
Provider Name (Legal Business Name): MINNA J KOHLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST YAWKEY 2C
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST YAWKEY2C
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-7938
  • Fax: 617-643-1274
Mailing address:
  • Phone: 617-726-7938
  • Fax: 617-643-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number222709
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number222709
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: