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General NPI Number Information
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NPI Number | 1821093535
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Entity Type | Individual
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Provider Name | MATTHEW P KOEHLER MD
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 28501 ORCHARD LAKE RD 120
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2951
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Country | US
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Telephone | 248-553-9800
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Fax | 248-553-9808
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Provider Business Mailing Address
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Address Line | 7225 OLD OAK BLVD #B303
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City | MIDDLEBURG HEIGHTS
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State | OH
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Zip | 44130
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Country | US
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Telephone | 440-243-7400
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Fax | 440-243-9034
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 049666
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 4301102751
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License Number State | MI
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