Provider Demographics
NPI:1053496745
Name:KOHN, HOWARD D (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:D
Last Name:KOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3844 S LINDBERGH BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1369
Mailing Address - Country:US
Mailing Address - Phone:314-525-0490
Mailing Address - Fax:
Practice Address - Street 1:3844 S LINDBERGH BLVD STE 120
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1369
Practice Address - Country:US
Practice Address - Phone:314-525-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6H79207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203773601Medicaid
G19928Medicare UPIN
MO203773601Medicaid