Provider Demographics
NPI:1346276706
Name:KOHL, LONNIE W (PA)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:W
Last Name:KOHL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9250 N 3RD ST
Mailing Address - Street 2:SUITE 4010
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2437
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:SUITE 209
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2624
Practice Address - Country:US
Practice Address - Phone:623-512-4320
Practice Address - Fax:623-512-4321
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3417207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ122816Medicaid
AZ122816Medicaid
AZZ130745Medicare PIN