Provider Demographics
NPI:1245229541
Name:KOHL, STEVEN D (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:KOHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1862
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:27031 W WARREN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1901
Practice Address - Country:US
Practice Address - Phone:313-274-3320
Practice Address - Fax:313-730-9222
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2020-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC6829OtherMCARE
MIH05453OtherHEALTH ALLIANCE PLAN
MI080153364OtherMETRAHEALTH
MA080D410020OtherBLUE CROSS BLUE SHIELD
MI0986431OtherHEALTH PLUS
MI4473150Medicaid
MI204120OtherMCLAREN HEALTH PLAN
MI0672088001OtherCIGNA
MI0854400315OtherBLUE CROSS BLUE SHIELD
MI080D410020OtherBLUE CARE NETWORK
MA204120OtherHEALTH ADVANTAGE NETWORK
MI7888019OtherAETNA
MIH05453Medicare UPIN
MI204120OtherMCLAREN HEALTH PLAN
MA0M28430Medicare ID - Type Unspecified