Provider Demographics
NPI:1518948165
Name:KOHN, ELIZABETH ROSEMARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROSEMARY
Last Name:KOHN
Suffix:
Gender:F
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:PO BOX 874049
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4049
Mailing Address - Country:US
Mailing Address - Phone:907-841-8361
Mailing Address - Fax:
Practice Address - Street 1:4410 106TH ST SW
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-4700
Practice Address - Country:US
Practice Address - Phone:425-259-0966
Practice Address - Fax:425-493-6014
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3790207Q00000X
MN39495207Q00000X
WAMD00034290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD0496Medicaid
AK8EA475Medicare PIN
AK8EB693Medicare PIN
F95135Medicare UPIN
AK8EA473Medicare PIN
AK8EB694Medicare PIN
AK8EA474Medicare PIN