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JARED M. KOHLENBERG D.O.

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1548498298

Individual Registrant:
 JARED M. KOHLENBERG D.O.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
670 COUNTY ROAD A  GREEN LAKE, WI 54941-8608 US
Tel: 920-294-0100  Fax: 920-294-0123

Contact information for business:
670 COUNTY ROAD A  GREEN LAKE, WI 54941-8608 US
Tel: 920-294-0100  Fax: 920-294-0123

Registration Information:
NPI: 1548498298
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
WI57315-21

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
1548498298WI05




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