Healthcare Provider Details

I. General information

NPI: 1457535593
Provider Name (Legal Business Name): JOAN M KOEWLER DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4157 CLARK RD
SARASOTA FL
34233-2403
US

IV. Provider business mailing address

4157 CLARK RD
SARASOTA FL
34233-2403
US

V. Phone/Fax

Practice location:
  • Phone: 941-923-4999
  • Fax: 941-923-4998
Mailing address:
  • Phone: 941-923-4999
  • Fax: 941-923-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 1696
License Number StateFL

VIII. Authorized Official

Name: DR. JOAN M KOEWLER
Title or Position: OWNER
Credential: DPM PA
Phone: 941-923-4999