Individual
MICHAEL PETER KOELSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
805 NORTH 6TH EAST, MOUNTAIN HOME, ID 83647
(208) 587-5880
(208) 587-7905
Mailing address
805 N 6TH EAST ST., MOUNTAIN HOME, ID 83647
(208) 587-5880
(208) 587-7905
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M3819
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010001549
REGENCE BLUE SHIELD
ID
01
—
57521
BLUE CROSS
ID
Enumeration date
10/18/2006
Last updated
07/08/2007
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