MEDICARE: DR. ALLISON MARIE LAKE KOEPKE MD

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
1	208000000X	Pediatrics Physician	MD89413	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184836447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLISON MARIE LAKE KOEPKE MD

Provider Business Mailing Address
First Line	:	167 BLUFFTON RD STE G
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-6228
Country	:	US
Telephone Number	:	843-757-8663
Fax Number	:	843-815-3849

Provider Business Practice Location Address
First Line	:	167 BLUFFTON RD STE G
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-6228
Country	:	US
Telephone Number	:	843-757-8663
Fax Number	:	843-815-3849

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	05/04/2026

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