Healthcare Provider Details

I. General information

NPI: 1629068325
Provider Name (Legal Business Name): SEAN R. KOHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 S 8TH ST BOONE COUNTY HEALTH CENTER
ALBION NE
68620-1760
US

IV. Provider business mailing address

PO BOX 350 BOONE COUNTY HEALTH CENTER
ALBION NE
68620-0350
US

V. Phone/Fax

Practice location:
  • Phone: 402-395-5013
  • Fax: 402-395-2327
Mailing address:
  • Phone: 402-395-5013
  • Fax: 402-395-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22341
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19365
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNE22341
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: