Provider Demographics
NPI:1215004973
Name:KOELZ, THOMAS ARDEN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ARDEN
Last Name:KOELZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13231 HUNTLEY CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55124-9484
Mailing Address - Country:US
Mailing Address - Phone:952-891-8561
Mailing Address - Fax:952-891-1485
Practice Address - Street 1:13231 HUNTLEY CT
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-9484
Practice Address - Country:US
Practice Address - Phone:952-891-8561
Practice Address - Fax:952-891-1485
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN16595207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND81280Medicare UPIN