Healthcare Provider Details

I. General information

NPI: 1093034746
Provider Name (Legal Business Name): KEVIN KOEHLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 INNOVATION DR STE 2000
GREENVILLE SC
29607-5253
US

IV. Provider business mailing address

26900 CEDAR RD
BEACHWOOD OH
44122-1191
US

V. Phone/Fax

Practice location:
  • Phone: 864-603-6300
  • Fax: 877-379-2919
Mailing address:
  • Phone: 216-839-2990
  • Fax: 216-839-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.121162
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number35.121162
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number93279
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35.121162
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35.121162
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: