MEDICARE: DR. CHARLES ROBERT 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	207R00000X	Internal Medicine Physician	35076187	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110201424	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	393446	OTHER	OH	WELLCARE OF OH
3	000000184421	OTHER	OH	UNICARE- LIFE AND HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	P76187	OTHER	OH	SUMMACARE HEALTH PLAN
6	000000184421	OTHER	OH	ANTHEM
7	341847368033	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1518951193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ROBERT KOEPKE MD

Provider Business Mailing Address
First Line	:	1440 ROCKSIDE RD STE 202
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-2749
Country	:	US
Telephone Number	:	216-749-8276
Fax Number	:	216-749-8240

Provider Business Practice Location Address
First Line	:	1440 ROCKSIDE RD STE 202
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134
Country	:	US
Telephone Number	:	216-749-8276
Fax Number	:	216-749-8240

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	05/31/2018

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Directions to “ DR. CHARLES ROBERT KOEPKE MD” Practice Location

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