Individual
SHANE K. KOHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8303 DODGE ST, OMAHA, NE 68114-4108
(402) 354-4540
(402) 354-4535
Mailing address
PO BOX 2797, OMAHA, NE 68103-2797
(402) 354-4230
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
24106
NE
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD00048195
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013105899
—
IA
01
—
24106
MEDICAL LICENSE
NE
05
—
47037660422
—
NE
01
—
MD00048195
MEDICAL LICENSE
WA
Enumeration date
10/05/2007
Last updated
12/17/2013
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