MEDICARE: DR. ANDREW KOOGLER M.D.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	60886566	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD60886566	OTHER	WA	WA LICENSE

General Provider Information

NPI Number	:	1851719421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW KOOGLER M.D.

Provider Business Mailing Address
First Line	:	410 W 10TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1240
Country	:	US
Telephone Number	:	614-293-8484
Fax Number	:

Provider Business Practice Location Address
First Line	:	11306 BRIDGEPORT WAY SW STE D
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3037
Country	:	US
Telephone Number	:	253-983-9390
Fax Number	:	360-733-8320

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

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	10/02/2019

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