Provider Demographics
NPI:1225089063
Name:KOHLER, HEIDI J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:J
Last Name:KOHLER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8905 W LINCOLN AVE
Mailing Address - Street 2:DIVISON OF ENDOCRINOLOGY
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2468
Mailing Address - Country:US
Mailing Address - Phone:414-328-6000
Mailing Address - Fax:414-328-8536
Practice Address - Street 1:8905 W LINCOLN AVE
Practice Address - Street 2:DIVISON OF ENDOCRINOLOGY
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2468
Practice Address - Country:US
Practice Address - Phone:414-328-6000
Practice Address - Fax:414-328-8536
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1295363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1225089063Medicaid
WI032T73601Medicare PIN
Q65645Medicare UPIN
WI1225089063Medicaid