Healthcare Provider Details

I. General information

NPI: 1750951661
Provider Name (Legal Business Name): MICAELA MARIE KOCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 WESTOWN PKWY
WEST DES MOINES IA
50266-7755
US

IV. Provider business mailing address

309 E CHURCH ST
MARSHALLTOWN IA
50158-2946
US

V. Phone/Fax

Practice location:
  • Phone: 515-223-8685
  • Fax:
Mailing address:
  • Phone: 641-754-6200
  • Fax: 641-754-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-54668
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: