Healthcare Provider Details

I. General information

NPI: 1598752446
Provider Name (Legal Business Name): MICHAEL C KOESTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 COBURG RD SLOCUM ORTHOPEDICS PC
EUGENE OR
97401-2433
US

IV. Provider business mailing address

55 COBURG RD SLOCUM ORTHOPEDICS PC
EUGENE OR
97401-2433
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-8111
  • Fax: 541-342-6379
Mailing address:
  • Phone: 541-485-8111
  • Fax: 541-342-6379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number21084
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00342319
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMC RAILROAD
# 2
Identifier288049
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: