Provider Demographics
NPI:1568771293
Name:KOH, PETER TONGBAK (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:TONGBAK
Last Name:KOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7753
Mailing Address - Country:US
Mailing Address - Phone:715-359-0299
Mailing Address - Fax:715-355-2159
Practice Address - Street 1:6209 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7753
Practice Address - Country:US
Practice Address - Phone:715-359-0299
Practice Address - Fax:715-355-2159
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20466-020207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology