Provider Demographics
NPI:1528158599
Name:KOHLI, NAEEM M (MD)
Entity type:Individual
Prefix:DR
First Name:NAEEM
Middle Name:M
Last Name:KOHLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MAPLE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401
Mailing Address - Country:US
Mailing Address - Phone:217-342-7034
Mailing Address - Fax:217-342-7036
Practice Address - Street 1:500 N MAPLE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401
Practice Address - Country:US
Practice Address - Phone:217-342-7034
Practice Address - Fax:217-342-7036
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360819662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
130009323OtherRR MEDICARE
010003OtherHEALTH ALLIANCE
IL036081966Medicaid
2505423OtherBCBS
236105OtherHEALTHLINK
IL036081966Medicaid
010003OtherHEALTH ALLIANCE