Provider Demographics
NPI:1851485346
Name:KOHN, BERNADETTE GOHEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:GOHEEN
Last Name:KOHN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 W. ELM STREET
Mailing Address - Street 2:SUITE Q
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4052
Mailing Address - Country:US
Mailing Address - Phone:815-344-0020
Mailing Address - Fax:815-344-0076
Practice Address - Street 1:5404 W. ELM STREET
Practice Address - Street 2:SUITE Q
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4052
Practice Address - Country:US
Practice Address - Phone:815-344-0020
Practice Address - Fax:815-344-0076
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00303608454204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC52073Medicare UPIN