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NPI Code Detail

MEDICARE: THOMAS E KOERNER MD

MEDICARE: THOMAS E KOERNER 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
1208800000XUrology Physician01025386AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396719811
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS E KOERNER MD
Provider Business Mailing Address
First Line : 10351 DAWSONS CREEK BLVD
Second Line : STE D
City : FORT WAYNE
State : IN
Zip : 46825-1904
Country : US
Telephone Number : 260-969-1950
Fax Number : 260-918-2137
Provider Business Practice Location Address
First Line : 2512 E DUPONT RD
Second Line : SUITE 100
City : FORT WAYNE
State : IN
Zip : 46825-1675
Country : US
Telephone Number : 260-436-6667
Fax Number : 260-469-7437
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 02/29/2012

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Directions to “ THOMAS E KOERNER MD” Practice Location

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