Healthcare Provider Details

I. General information

NPI: 1679545115
Provider Name (Legal Business Name): WAYNE H KOHN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BAKER ST THIRD FLOOR
MUSKEGON MI
49444-2157
US

IV. Provider business mailing address

1468 ROOD POINT RD
MUSKEGON MI
49441-4845
US

V. Phone/Fax

Practice location:
  • Phone: 231-737-1335
  • Fax: 231-737-0534
Mailing address:
  • Phone: 231-798-1561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101009756
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: