# VINOD KOHLI MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760636971
- **Authorized official:** MR. VINOD KOHLI M.D. (PRESIDENT)
- **Authorized official phone:** (586) 530-2197

## Contact information

- **Practice address:** 25511 VAN DYKE AVENUE, SUITE 200, CENTER LINE, MI 48015-1834
- **Practice address phone:** (586) 759-6300
- **Practice address fax:** (586) 759-1409
- **Mailing address:** 25511 VAN DYKE AVENUE, SUITE 200, CENTER LINE, MI 48015-1834
- **Mailing address phone:** (586) 759-6300
- **Mailing address fax:** (586) 759-1409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4301040989 | MI | Yes |

## Other

- **Enumeration date:** 11/14/2008
- **Last updated:** 07/17/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0105005271 | BCBS | MI |
| 05 | — | MI335057710 | — | MI |