Healthcare Provider Details

I. General information

NPI: 1760636971
Provider Name (Legal Business Name): VINOD KOHLI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 07/17/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25511 VAN DYKE AVENUE SUITE 200
CENTER LINE MI
48015-1834
US

IV. Provider business mailing address

25511 VAN DYKE AVENUE SUITE 200
CENTER LINE MI
48015-1834
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-6300
  • Fax: 586-759-1409
Mailing address:
  • Phone: 586-759-6300
  • Fax: 586-759-1409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301040989
License Number StateMI

VIII. Authorized Official

Name: MR. VINOD KOHLI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 586-530-2197