MEDICARE: JOHN KOEHLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PT0002X	Medical Toxicology (Emergency Medicine) Physician	36072658	IL
2	207P00000X	Emergency Medicine Physician	ME133563	FL

General Provider Information

NPI Number	:	1144207366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN KOEHLER MD

Provider Business Mailing Address
First Line	:	1840 ELDRON BLVD SE STE 1
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6871
Country	:	US
Telephone Number	:	321-312-4580
Fax Number	:	321-914-4053

Provider Business Practice Location Address
First Line	:	1840 ELDRON BLVD SE STE 1
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6871
Country	:	US
Telephone Number	:	321-312-4580
Fax Number	:	321-914-4053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	03/17/2018

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Directions to “ JOHN KOEHLER MD” Practice Location

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