Provider Demographics
NPI:1194751156
Name:BOHN, KATHRYN SUE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:SUE
Last Name:BOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 GERIG DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-6365
Mailing Address - Country:US
Mailing Address - Phone:309-862-4000
Mailing Address - Fax:309-862-4055
Practice Address - Street 1:3302 GERIG DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-6365
Practice Address - Country:US
Practice Address - Phone:309-862-4000
Practice Address - Fax:309-862-4055
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071833202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071833-1Medicaid
IL05721369OtherBC/BS
IL05721369OtherBC/BS
ILK46462Medicare PIN