Provider Demographics
NPI:1659371441
Name:KOHLHEPP, MARGUERITE MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:MARY
Last Name:KOHLHEPP
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 1:403 VONDERBURG DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5982
Mailing Address - Country:US
Mailing Address - Phone:813-681-1122
Mailing Address - Fax:813-684-4924
Practice Address - Street 1:403 VONDERBURG DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5982
Practice Address - Country:US
Practice Address - Phone:813-681-1122
Practice Address - Fax:813-684-4924
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076125207W00000X
FLME76125207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58545OtherBCBSFL
FL3353345OtherCIGNA
NY9666437OtherGHI
FL7514064OtherAETNA
FL264786900Medicaid
GAP00247471Medicare PIN
FL58545JMedicare PIN
FL3353345OtherCIGNA
FL58545IMedicare PIN
FL58545RMedicare PIN
FL58545OtherBCBSFL
FL58545KMedicare PIN
NY9666437OtherGHI
FL264786900Medicaid
FL58545PMedicare PIN