Provider Demographics
NPI:1457521866
Name:KOHLER, MYLAN VAUGEOIS (DO)
Entity type:Individual
Prefix:
First Name:MYLAN
Middle Name:VAUGEOIS
Last Name:KOHLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MYLAN
Other - Middle Name:NGO THI
Other - Last Name:VAUGEOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 22040
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2040
Mailing Address - Country:US
Mailing Address - Phone:920-433-6073
Mailing Address - Fax:
Practice Address - Street 1:1325 ANGELS PATH
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-4050
Practice Address - Country:US
Practice Address - Phone:920-338-2855
Practice Address - Fax:920-338-9270
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54443-0212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry