Provider Demographics
NPI:1659345171
Name:KOHL, JOHNNA L (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:L
Last Name:KOHL
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 1:4001 DALE STREET STE 210
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-929-5888
Mailing Address - Fax:907-929-5886
Practice Address - Street 1:4001 DALE ST
Practice Address - Street 2:STE 210
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-929-5888
Practice Address - Fax:907-929-5886
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4771208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD44124Medicaid
AKMD44124Medicaid
H87277Medicare UPIN
152654Medicare ID - Type Unspecified