MEDICARE: MICHAEL SHANE KOHANSKI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	M2992	TX

General Provider Information

NPI Number	:	1255378691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SHANE KOHANSKI M.D.

Provider Business Mailing Address
First Line	:	4131 N CENTRAL EXPY
Second Line	:	SUITE 435
City	:	DALLAS
State	:	TX
Zip	:	75204-2102
Country	:	US
Telephone Number	:	214-252-3501
Fax Number	:

Provider Business Practice Location Address
First Line	:	4131 N CENTRAL EXPY
Second Line	:	SUITE 435
City	:	DALLAS
State	:	TX
Zip	:	75204-2102
Country	:	US
Telephone Number	:	214-252-3501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/13/2007

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