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NPI Code Detail

MEDICARE: JEANETTE DILAN-KOETJE D.O.

MEDICARE: JEANETTE DILAN-KOETJE D.O.
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
1207P00000XEmergency Medicine Physician2023032035MO
2207P00000XEmergency Medicine PhysicianOS13778FL
3207P00000XEmergency Medicine PhysicianE-13447AR
4207R00000XInternal Medicine Physician226611MS
5207R00000XInternal Medicine Physician2023032035MO

Other Identifiers

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

General Provider Information

NPI Number : 1538499454
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANETTE DILAN-KOETJE D.O.
Provider Business Mailing Address
First Line : 54 HOSPITAL DR
Second Line :
City : OSAGE BEACH
State : MO
Zip : 65065-3050
Country : US
Telephone Number : 573-348-8000
Fax Number :
Provider Business Practice Location Address
First Line : 304A E 4TH ST
Second Line :
City : ELDON
State : MO
Zip : 65026-1808
Country : US
Telephone Number : 573-392-5654
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2009
Last Update Date : 07/30/2025

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