Individual
DR. MARK THOMAS KOEHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8765 LEWIS AVE, TEMPERANCE, MI 48182-9583
(734) 847-3802
(734) 847-3418
Mailing address
8765 LEWIS AVE, TEMPERANCE, MI 48182-9583
(734) 847-3802
(734) 847-3418
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301055332
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02214
PARAMOUNT HEALTH CARE
MI
01
—
05816
HEALTH PLAN OF MICHIGAN
MI
05
—
2047421
—
OH
05
—
2652573
—
MI
01
—
700E86031
BCBS OF MICHIGAN
MI
Enumeration date
01/06/2006
Last updated
03/05/2009
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