MEDICARE: DR. JUDITH P 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	2084N0400X	Neurology Physician	G22685	CA
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	G22685	CA

General Provider Information

NPI Number	:	1518228154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH P KOEHLER MD

Provider Business Mailing Address
First Line	:	1501 CAPITOL AVE
Second Line	:	POB 997419 MS 4505
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-5005
Country	:	US
Telephone Number	:	916-949-4929
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 CAPITOL AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-5005
Country	:	US
Telephone Number	:	916-949-4929
Fax Number	:

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

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	05/17/2026

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