Provider Demographics
NPI:1447459771
Name:KOHLI, PAYAL (MD)
Entity type:Individual
Prefix:DR
First Name:PAYAL
Middle Name:
Last Name:KOHLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 S POTOMAC ST STE 190
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4542
Mailing Address - Country:US
Mailing Address - Phone:303-364-1057
Mailing Address - Fax:833-916-2265
Practice Address - Street 1:1411 S POTOMAC ST STE 190
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4542
Practice Address - Country:US
Practice Address - Phone:303-364-1057
Practice Address - Fax:833-916-2265
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232991207R00000X
CA121334207RC0000X
CODR.0054941207RC0000X
CO0054941207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56733844Medicaid
CO025762OtherKAISER COMMERCIAL NUMBER
CO56733844Medicaid