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NPI Code Detail

MEDICARE: DR. MARK THOMAS KOEHL M.D.

MEDICARE: DR. MARK THOMAS KOEHL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician4301055332MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
205816OTHERMIHEALTH PLAN OF MICHIGAN
3700E86031OTHERMIBCBS OF MICHIGAN
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
502214OTHERMIPARAMOUNT HEALTH CARE

General Provider Information

NPI Number : 1053399220
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK THOMAS KOEHL M.D.
Provider Business Mailing Address
First Line : 8765 LEWIS AVE
Second Line :
City : TEMPERANCE
State : MI
Zip : 48182-9583
Country : US
Telephone Number : 734-847-3802
Fax Number : 734-847-3418
Provider Business Practice Location Address
First Line : 8765 LEWIS AVE
Second Line :
City : TEMPERANCE
State : MI
Zip : 48182-9583
Country : US
Telephone Number : 734-847-3802
Fax Number : 734-847-3418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 03/05/2009

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