MEDICARE: GERARD G KOEHN 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
1	174400000X	Specialist	16610	CO

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	:	1619962768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARD G KOEHN M.D.

Provider Business Mailing Address
First Line	:	595 CHAPEL HILLS DR
Second Line	:	SUITE 303
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1022
Country	:	US
Telephone Number	:	719-574-0310
Fax Number	:	719-574-6574

Provider Business Practice Location Address
First Line	:	595 CHAPEL HILLS DR
Second Line	:	SUITE 303
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1022
Country	:	US
Telephone Number	:	719-574-0310
Fax Number	:	719-574-6574

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	10/17/2007

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