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Organization

MICHAEL P KOELSCH MD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY LOU KOELSCH (OFFICE MANAGER)
(208) 587-5880
Entity
Organization

Contact information

Practice address
805 N 6TH E, MOUNTAIN HOME, ID 83647-2207
(208) 587-5880
(208) 587-7905
Mailing address
PO BOX 940, MOUNTAIN HOME, ID 83647-0940
(208) 587-5880
(208) 587-7905

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M3819
ID
363LF0000X
Family Nurse Practitioner
NP382A
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
805234300
ID
01
8H732
BLUE CROSS GROUP
ID
Enumeration date
03/15/2007
Last updated
09/20/2013
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