Provider Demographics
NPI:1285633685
Name:KOHLI, DARRELL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:J
Last Name:KOHLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1015 S LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-2100
Mailing Address - Country:US
Mailing Address - Phone:906-474-6003
Mailing Address - Fax:906-786-7403
Practice Address - Street 1:1015 S LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-2100
Practice Address - Country:US
Practice Address - Phone:906-786-5181
Practice Address - Fax:906-786-7403
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI052758207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102758320Medicaid
MI180B160140OtherBLUE CROSS BLUE SHIELD
MI1497792386OtherUP OPHTHALMOLOGY GR NPI
MI180012681OtherRAILROAD MEDICARE
MI102758320Medicaid
MI180B160140OtherBLUE CROSS BLUE SHIELD
MIE82632Medicare UPIN
MI180012681Medicare PIN
MI0B16014002Medicare PIN