Provider Demographics
NPI:1841219052
Name:KOHLES, BRIAN K (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:KOHLES
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 1:1815 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-3164
Mailing Address - Country:US
Mailing Address - Phone:765-393-1488
Mailing Address - Fax:765-400-5217
Practice Address - Street 1:1815 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-3164
Practice Address - Country:US
Practice Address - Phone:765-393-1488
Practice Address - Fax:765-400-5217
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040490A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100351320Medicaid
IN000000313021OtherANTHEM
IN000000313021OtherANTHEM
IN100351320Medicaid
INP00112747Medicare PIN
IN213360BMedicare PIN