MEDICARE: LAWRENCE KOEGEL JR. 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	207Y00000X	Otolaryngology Physician	35043623K	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1528030921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE KOEGEL JR. MD

Provider Business Mailing Address
First Line	:	1810 MACKENZIE DR
Second Line	:	2ND FLOOR
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2967
Country	:	US
Telephone Number	:	614-273-2234
Fax Number	:	614-273-2255

Provider Business Practice Location Address
First Line	:	477 COOPER RD
Second Line	:	SUITE 480
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-8053
Country	:	US
Telephone Number	:	614-882-5647
Fax Number	:	614-823-7137

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	02/04/2010

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