Provider Demographics
NPI:1770681470
Name:KOHLI, VINOD KUMAR (MD)
Entity type:Individual
Prefix:MR
First Name:VINOD
Middle Name:KUMAR
Last Name:KOHLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25511 VAN DYKE AVENUE
Mailing Address - Street 2:SUITE-200
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1834
Mailing Address - Country:US
Mailing Address - Phone:586-530-2197
Mailing Address - Fax:586-759-1409
Practice Address - Street 1:25511 VAN DYKE AVENUE
Practice Address - Street 2:SUITE-200
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1834
Practice Address - Country:US
Practice Address - Phone:586-530-2197
Practice Address - Fax:586-759-1409
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301-040989208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI335057710Medicaid
B47210Medicare UPIN
MIMI335057710Medicaid