Provider Demographics
NPI:1316901085
Name:KOHLS, REGINA ANN (MD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:KOHLS
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:PO BOX 636541
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6541
Mailing Address - Country:US
Mailing Address - Phone:513-263-1532
Mailing Address - Fax:513-263-8622
Practice Address - Street 1:3248 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5140
Practice Address - Country:US
Practice Address - Phone:513-674-1400
Practice Address - Fax:513-206-1902
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0975959Medicaid
OH0975959Medicaid
OHKO4012325Medicare ID - Type Unspecified