MEDICARE: MR. DOUGLAS O KOHLER MD

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	207R00000X	Internal Medicine Physician	35071467	OH
2	207R00000X	Internal Medicine Physician	35071467K	OH

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	:	1770584591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS O KOHLER MD

Provider Business Mailing Address
First Line	:	12000 MCCRACKEN ROAD
Second Line	:	SUITE 550
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125
Country	:	US
Telephone Number	:	216-663-8686
Fax Number	:	216-663-2153

Provider Business Practice Location Address
First Line	:	12000 MCCRACKEN ROAD
Second Line	:	SUITE 550
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125
Country	:	US
Telephone Number	:	216-663-8686
Fax Number	:	216-663-2153

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	09/03/2010

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