MEDICARE: RICHARD A KOEPKE 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
1	207Q00000X	Family Medicine Physician	5101011998	MI
2	207Q00000X	Family Medicine Physician	34.002926	OH

General Provider Information

NPI Number	:	1891797510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD A KOEPKE D.O.

Provider Business Mailing Address
First Line	:	2200 JEFFERSON AVE
Second Line	:	4TH FLOOR
City	:	TOLEDO
State	:	OH
Zip	:	43604-7101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4126 N HOLLAND SYLVANIA RD
Second Line	:	SUITE 220
City	:	TOLEDO
State	:	OH
Zip	:	43623-3536
Country	:	US
Telephone Number	:	419-517-7600
Fax Number	:	419-517-7610

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	10/29/2014

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Directions to “ RICHARD A KOEPKE D.O.” Practice Location

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