Provider Demographics
NPI:1457381188
Name:HISER-KOHLER, MELISSA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:M
Last Name:HISER-KOHLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:M
Other - Last Name:HISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5395
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:200 E CHESTNUT ST BLDG SUITE303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200852080OtherIN MEDICAID/NORTON
0000570941OtherNIS/HUMANA
50020898OtherPASSPORT
KY7695805OtherAETNA
KY000000484201OtherANTHEM
IN200852080Medicaid
000000587248OtherNIS/ANTHEM
0720442OtherNIS/CIGNA
099722OtherNIS/SIHO
KY7100005210Medicaid
000000587248OtherNIS/ANTHEM
I55440Medicare UPIN
IN200852080Medicaid