Individual
JARED M. KOHLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
670 COUNTY ROAD A, GREEN LAKE, WI 54941-8608
(920) 294-0100
(920) 294-0123
Mailing address
670 COUNTY ROAD A, GREEN LAKE, WI 54941-8608
(920) 294-0100
(920) 294-0123
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
57315-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548498298
—
WI
Enumeration date
07/01/2009
Last updated
05/14/2015
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