Provider Demographics
NPI:1467879825
Name:KOHUT, TAISA JUDE (MD)
Entity type:Individual
Prefix:
First Name:TAISA
Middle Name:JUDE
Last Name:KOHUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 225
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1423
Mailing Address - Country:US
Mailing Address - Phone:407-303-9926
Mailing Address - Fax:
Practice Address - Street 1:615 E PRINCETON ST STE 225
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1423
Practice Address - Country:US
Practice Address - Phone:407-303-9926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1501042080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty