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NPI Code Detail

MEDICARE: WYATT SAMUEL KOOLMEES MD

MEDICARE: WYATT SAMUEL KOOLMEES 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
1207R00000XInternal Medicine PhysicianR82389AZ

General Provider Information

NPI Number : 1548107816
Entity Type Code : Individual
Provider Name (Legal Business Name) : WYATT SAMUEL KOOLMEES MD
Provider Business Mailing Address
First Line : 1111 E MCDOWELL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85006-2612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1300 N 12TH ST STE 508
Second Line :
City : PHOENIX
State : AZ
Zip : 85006-2849
Country : US
Telephone Number : 602-839-3927
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2026
Last Update Date : 05/04/2026

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Directions to “ WYATT SAMUEL KOOLMEES MD” Practice Location

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