Physician Compare National (NPI:1902004070)

HEALTHCARE PROVIDER: DEBBIE KOELTZOW EDD, LP

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1902004070
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7416085311
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100513001018
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KOELTZOW
	Individual professional last name
Provider First Name	DEBBIE
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	5516 DEXTER PINCKNEY RD
	Group Practice or individual's line 1 address
City	DEXTER
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	481309587
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y