Provider Demographics
NPI:1629068325
Name:KOHL, SEAN R (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:R
Last Name:KOHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:BOONE COUNTY HEALTH CENTER
Mailing Address - City:ALBION
Mailing Address - State:NE
Mailing Address - Zip Code:68620-0350
Mailing Address - Country:US
Mailing Address - Phone:402-395-5013
Mailing Address - Fax:402-395-2327
Practice Address - Street 1:1019 S 8TH ST
Practice Address - Street 2:BOONE COUNTY HEALTH CENTER
Practice Address - City:ALBION
Practice Address - State:NE
Practice Address - Zip Code:68620-1760
Practice Address - Country:US
Practice Address - Phone:402-395-5013
Practice Address - Fax:402-395-2327
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE22341207Q00000X
NE19365207Q00000X
NENE22341207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE242156OtherMIDLANDS CHOICE
NE04360OtherBLUE CROSS BLUE SHIELD
H84549Medicare UPIN
NE04360OtherBLUE CROSS BLUE SHIELD
NEH84549Medicare UPIN
278132Medicare Oscar/Certification
NEP001597523Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE