1457381188 NPI number — MRS. MELISSA M HISER-KOHLER M.D.

Table of content: MRS. MELISSA M HISER-KOHLER M.D. (NPI 1457381188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457381188 NPI number — MRS. MELISSA M HISER-KOHLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HISER-KOHLER
Provider First Name:
MELISSA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HISER
Provider Other First Name:
MELISSA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457381188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-272-5395
Provider Business Mailing Address Fax Number:
502-272-5339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E CHESTNUT ST BLDG SUITE303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-629-5552
Provider Business Practice Location Address Fax Number:
502-629-3132
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  40672 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200852080 . This is a "IN MEDICAID/NORTON" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0000570941 . This is a "NIS/HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50020898 . This is a "PASSPORT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7695805 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000484201 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200852080 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000587248 . This is a "NIS/ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0720442 . This is a "NIS/CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 099722 . This is a "NIS/SIHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100005210 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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