MEDICARE: ROBIN FREDERICK KOELEVELD 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	207T00000X	Neurological Surgery Physician	35684	NC

General Provider Information

NPI Number	:	1932174372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN FREDERICK KOELEVELD MD

Provider Business Mailing Address
First Line	:	4207 LAKE BOONE TRL STE 220
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6685
Country	:	US
Telephone Number	:	919-784-1410
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 LAKE BOONE TRL STE 220
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6685
Country	:	US
Telephone Number	:	919-784-1410
Fax Number	:

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	05/08/2020

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