Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 24116 | WI |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 80209 | GA |
NPI | 1063405728 |
---|---|
Provider Name | Alka Kohli |
First Address | Brookfield, WI 53005-5721 |
Second Address | Brookfield, WI 53005-5721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 31/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30619500 | (05) | WI |
B54253 | (02) | WI |