Individual
DR. CHAD ANDREW KOHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
677 N WILMOT RD, TUCSON, AZ 85711-2701
(520) 795-2889
(520) 795-6321
Mailing address
677 N WILMOT RD, TUCSON, AZ 85711-2701
(520) 795-2889
(520) 795-6321
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
42086
AZ
2085R0202X
Diagnostic Radiology Physician
Primary
42086
AZ
2085U0001X
Diagnostic Ultrasound Physician
42086
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005472
GROUP MEDICAID ID
AZ
01
—
1306008313
PROVIDER NPI NUMBER
AZ
01
—
1841261989
GROUP NPI
AZ
05
—
724694
—
AZ
01
—
CS7943
GROUP MEDICARE RAILROAD ID & PTAN
AZ
01
—
P01323741
MEDICARE RAILROAD ID FOR PHYSICIAN
AZ
01
—
Z162726
PROVIDER PTAN
AZ
01
—
ZWCBBM
GROUP MEDICARE ID
AZ
Enumeration date
06/30/2008
Last updated
07/29/2014
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