Individual
MARK E KOHLHASE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5200 FAIRVIEW BLVD, WYOMING, MN 55092-8013
(651) 982-7659
Mailing address
10490 261ST ST, CHISAGO CITY, MN 55013-5201
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9066
MN
Other
Enumeration date
05/16/2006
Last updated
07/08/2007
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