Individual
MARK KOEHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1721 MAGNAVOX WAY, FORT WAYNE, IN 46804-1537
(260) 748-3650
Mailing address
1721 MAGNAVOX WAY STE B, FORT WAYNE, IN 46804-1537
(260) 748-3650
(260) 748-3651
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/04/2025
Last updated
09/04/2025
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