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General NPI Number Information
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NPI Number | 1134299282
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Entity Type | Organization
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Legal Business Name | ISABEL H KOELSCH MD
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1850 W MOUNTAIN VIEW AVE
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City | LONGMONT
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State | CO
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Zip | 80501
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Country | US
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Telephone | 303-776-1500
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Fax | 303-772-2995
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Provider Business Mailing Address
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Address Line | 1850 W MOUNTAIN VIEW AVE
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City | LONGMONT
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State | CO
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Zip | 80501
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Country | US
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Telephone | 303-776-1500
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Fax | 303-772-2995
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ISABEL H KOELSCH
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Credential | MD
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Telephone | 303-776-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 23406
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License Number State | CO
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