Provider Demographics
NPI:1528098811
Name:KOHL, SUSAN E (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:KOHL
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 849931
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0001
Mailing Address - Country:US
Mailing Address - Phone:214-821-1177
Mailing Address - Fax:214-821-1193
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:#550
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1904
Practice Address - Country:US
Practice Address - Phone:214-821-1177
Practice Address - Fax:214-821-1193
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5599208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047935401Medicaid
TX89V390OtherBCBS
TX89V390Medicare PIN