Provider Demographics
NPI:1356389829
Name:KOLAR, MARK J (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:KOLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-856-8200
Mailing Address - Fax:859-586-8233
Practice Address - Street 1:6159 1ST FINANCIAL DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-7892
Practice Address - Country:US
Practice Address - Phone:859-586-8200
Practice Address - Fax:859-586-8233
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00839844OtherRAILROAD MEDICARE
KYP00141835OtherRAILROAD MEDICARE
OH2524807Medicaid
KY64083967Medicaid
KY64083967Medicaid
KYP00839844OtherRAILROAD MEDICARE
KY0398232Medicare PIN