Provider Demographics
NPI:1194770347
Name:KOHLER, JANINE (DO)
Entity type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:KOHLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 N ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-9292
Mailing Address - Country:US
Mailing Address - Phone:231-935-0850
Mailing Address - Fax:231-935-0869
Practice Address - Street 1:5015 N ROYAL DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9292
Practice Address - Country:US
Practice Address - Phone:231-935-0850
Practice Address - Fax:231-935-0850
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4188925Medicaid
MI7066114OtherAETNA
MI1067440OtherMCLAREN
MI200000026814OtherPHYSICIANS HEALTH PLAN
MI0M93950Medicare ID - Type Unspecified
MI4188925Medicaid
MIM21440081Medicare PIN