Individual
JOHN M KOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
202 CENTER AVE., STE. 102, KODIAK, AK 99615-1126
(907) 486-6188
(907) 486-6146
Mailing address
PO BOX 1126, KODIAK, AK 99615-1126
(907) 486-6188
(907) 486-6146
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
3737
AK
207Q00000X
Family Medicine Physician
Primary
S3737
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K151630
MEDICARE ID ( DEACTIVATED AFTER 5.16.09)
—
01
—
K162501
MEDICARE ID 6.29.09 - PRESENT
—
05
—
MD10072
—
AK
Enumeration date
01/02/2007
Last updated
01/10/2018
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