Individual provider Active NPI

Kohl Douglas Gullett

  • Emergency Medicine Physician
  • Wyoming, MI
National Provider Identifier
1063108413
Registry record updated Jun 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
DO-55709 Issued in IA
Practice address
5900 Byron Center Ave SW
Wyoming, MI 49519-9606
Phone
(616) 252-7200
Fax
(616) 252-4953
NPI assigned
Apr 17, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X DO-55709 IA Primary

Addresses

Primary practice location

5900 Byron Center Ave SW
Wyoming, MI 49519-9606

Mailing address

3001 NW 73Rd LN
Ankeny, IA 50023-9107
Phone (515) 339-5609

Other practice location 1

1111 6th Ave
Des Moines, IA 50314-2613
Phone (515) 247-3121

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230707002471 MI Order and Referring Only - Emergency MedicinePractitioner - Emergency Medicine 2163881285

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

5665 New Northside Dr
Sandy Springs, GA 30328-5834

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781049600000",
    "number": "1063108413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 NW 73RD LN",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500239107",
            "telephone_number": "515-339-5609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199606",
            "telephone_number": "616-252-7200",
            "fax_number": "616-252-4953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 6th Ave",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503142613",
            "country_code": "US",
            "telephone_number": "515-247-3121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GULLETT",
        "first_name": "KOHL",
        "middle_name": "DOUGLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-17",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IA",
            "license": "DO-55709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.