Provider Demographics
NPI:1891911160
Name:MANOJ KOHLI, PSC
Entity Type:Organization
Organization Name:MANOJ KOHLI, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-260-1563
Mailing Address - Street 1:151 N EAGLE CREEK DR
Mailing Address - Street 2:STE 12
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1889
Mailing Address - Country:US
Mailing Address - Phone:859-263-0050
Mailing Address - Fax:859-263-7441
Practice Address - Street 1:2393 ALUMNI DR
Practice Address - Street 2:STE 205
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4285
Practice Address - Country:US
Practice Address - Phone:859-260-1563
Practice Address - Fax:859-260-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64-021496Medicaid
KY64-021496Medicaid
KYF04421Medicare UPIN