Provider Demographics
NPI:1528053626
Name:KOHLMEIER, LYNN B (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:B
Last Name:KOHLMEIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:B
Other - Last Name:RUECHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:849 WHISPER FALLS LN
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-9503
Mailing Address - Country:US
Mailing Address - Phone:262-227-0194
Mailing Address - Fax:
Practice Address - Street 1:130 2ND ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2883
Practice Address - Country:US
Practice Address - Phone:920-969-7906
Practice Address - Fax:920-969-7979
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31381208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528053626Medicaid
WI01750Medicare ID - Type Unspecified
WI31850200Medicaid