MEDICARE: JARED M. KOHLENBERG D.O.

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	207Q00000X	Family Medicine Physician	57315-21	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548498298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED M. KOHLENBERG D.O.

Provider Business Mailing Address
First Line	:	670 COUNTY ROAD A
Second Line	:
City	:	GREEN LAKE
State	:	WI
Zip	:	54941-8608
Country	:	US
Telephone Number	:	920-294-0100
Fax Number	:	920-294-0123

Provider Business Practice Location Address
First Line	:	670 COUNTY ROAD A
Second Line	:
City	:	GREEN LAKE
State	:	WI
Zip	:	54941-8608
Country	:	US
Telephone Number	:	920-294-0100
Fax Number	:	920-294-0123

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

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	05/14/2015

Similar Medicare Providers

1285030957 — MRS. SANDRA SCHWOERER MSN, FNP
Practice Location Address:

670 COUNTY ROAD A
GREEN LAKE, WI
54941-8608

Practice Phone: 920-294-0100
Practice Fax: 920-294-0123

1467080739 — COURTNEY MCCLINTIC MD
Practice Location Address:

670 COUNTY ROAD A
GREEN LAKE, WI
54941-8608

Practice Phone: 920-294-0100
Practice Fax: 920-294-0123

1811319270 — MITZI LYNN LEAHY M.S., CCC-SLP
Practice Location Address:

865 TIMBER LAKE TRL
CUMMING, GA
30041-8608

Practice Phone: 678-456-8978
Practice Fax:

1801243001 — KRISTY OLSON
Practice Location Address:

8608 ELM ST
WONDER LAKE, IL
60097-9443

Practice Phone: 815-321-1922
Practice Fax:

1417642562 — MICHELLE MARIE FODCZUK
Practice Location Address:

4926 N ISLAND DR E
BONNEY LAKE, WA
98391-8608

Practice Phone: 425-365-6968
Practice Fax: 425-386-5065

1669152435 — EYES UNLIMITED, INC.
Practice Location Address:

3112 LAKE SHORE AVE
MAPLE PLAIN, MN
55359-8608

Practice Phone: 763-843-4264
Practice Fax:

Directions to “ JARED M. KOHLENBERG D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.