Healthcare Provider Details

I. General information

NPI: 1346316239
Provider Name (Legal Business Name): RAVEN A KOEPPLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 S 108TH ST GREENFIELD HIGHLANDS HEALTH CENTER
MILWAUKEE WI
53228-2504
US

IV. Provider business mailing address

4455 S 108TH ST GREENFIELD HIGHLANDS HEALTH CENTER
MILWAUKEE WI
53228-2504
US

V. Phone/Fax

Practice location:
  • Phone: 414-427-5310
  • Fax: 414-427-5311
Mailing address:
  • Phone: 414-427-5310
  • Fax: 414-427-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number51629
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: