Provider Demographics
NPI:1700850690
Name:KOHN, JOHN CLEMENT (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLEMENT
Last Name:KOHN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1040
Mailing Address - Country:US
Mailing Address - Phone:810-720-8900
Mailing Address - Fax:810-720-1417
Practice Address - Street 1:5202 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1040
Practice Address - Country:US
Practice Address - Phone:810-720-8900
Practice Address - Fax:810-720-1417
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008346174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4282874Medicaid
MI0B54542Medicare ID - Type Unspecified
MIF97788Medicare UPIN