Provider Demographics
NPI:1104849876
Name:KOHLHAAS, ALAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:KOHLHAAS
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 1:555 E. EADS PKWY, STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-7385
Mailing Address - Country:US
Mailing Address - Phone:812-537-5722
Mailing Address - Fax:812-537-4131
Practice Address - Street 1:555 E. EADS PKWY, STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-7385
Practice Address - Country:US
Practice Address - Phone:812-537-5722
Practice Address - Fax:812-537-4131
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010308148207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100093680AMedicaid
IN0208680001Medicare NSC
IN100093680AMedicaid