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General NPI Number Information
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NPI Number | 1215948146
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Entity Type | Individual
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Provider Name | MANOJ KOHLI MD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1730 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3809
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Country | US
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Telephone | 217-329-1000
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Fax | 217-329-1055
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Provider Business Mailing Address
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Address Line | 1730 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3809
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Country | US
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Telephone | 217-329-1000
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Fax | 217-329-1055
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 036127290
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 35622
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License Number State | KY
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