Provider Demographics
NPI:1760636971
Name:VINOD KOHLI MD PC
Entity type:Organization
Organization Name:VINOD KOHLI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-530-2197
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:586-759-6300
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:586-759-6300
Practice Address - Fax:586-759-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040989208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0105005271OtherBCBS
MIMI335057710Medicaid