Provider Demographics
NPI:1669431375
Name:KOHLI, HARJIT KAUR (MD)
Entity type:Individual
Prefix:
First Name:HARJIT
Middle Name:KAUR
Last Name:KOHLI
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 1:26650 EUREKA RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4835
Mailing Address - Country:US
Mailing Address - Phone:734-941-4991
Mailing Address - Fax:734-941-4919
Practice Address - Street 1:26650 EUREKA RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4835
Practice Address - Country:US
Practice Address - Phone:734-941-4991
Practice Address - Fax:734-941-4919
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1669431375Medicaid
0H24999OtherBCBSM
MI1669431375Medicaid