Healthcare Provider Details

I. General information

NPI: 1285637918
Provider Name (Legal Business Name): CHANDER M. KOHLI M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 PARMALEE AVE STE 310
YOUNGSTOWN OH
44510-1605
US

IV. Provider business mailing address

540 PARMALEE AVE STE 310
YOUNGSTOWN OH
44510-1605
US

V. Phone/Fax

Practice location:
  • Phone: 330-747-1420
  • Fax: 330-747-1151
Mailing address:
  • Phone: 330-747-1420
  • Fax: 330-747-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35-03-4176 K
License Number StateOH

VIII. Authorized Official

Name: DR. CHANDER M KOHLI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-747-1420