Provider Demographics
NPI:1962419234
Name:KOEHLER, MICHAEL K (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:KOEHLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-708-1555
Mailing Address - Fax:440-708-1515
Practice Address - Street 1:8185 WASHINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4575
Practice Address - Country:US
Practice Address - Phone:440-708-1515
Practice Address - Fax:440-708-1515
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062965207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0184812Medicaid
OHG05984Medicare UPIN
OH0784874Medicare PIN