1528158599 NPI number — DR. NAEEM M KOHLI MD

Table of content: DR. NAEEM M KOHLI MD (NPI 1528158599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528158599 NPI number — DR. NAEEM M KOHLI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOHLI
Provider First Name:
NAEEM
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528158599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 N MAPLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EFFINGHAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-342-7034
Provider Business Mailing Address Fax Number:
217-342-7036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 N MAPLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-342-7034
Provider Business Practice Location Address Fax Number:
217-342-7036
Provider Enumeration Date:
10/13/2006

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: 2084N0400X , with the licence number:  036081966 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 130009323 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010003 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 036081966 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2505423 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 236105 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".




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