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General NPI Number Information
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NPI Number | 1245812106
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Entity Type | Individual
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Provider Name | SAMUEL DAVID KOEBE MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 1000 MINERAL POINT AVE
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City | JANESVILLE
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State | WI
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Zip | 53548-2940
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Country | US
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Telephone | 608-756-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 29624 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1296
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Country | US
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Telephone | 608-756-6278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 81759
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License Number State | WI
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