Individual
SCOTT MARK KOEHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 JEFFERSON RD, NORTHFIELD, MN 55057-3081
(507) 663-9000
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
43309
MN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
43309
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
482493800
—
MN
Enumeration date
04/13/2006
Last updated
11/09/2020
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