Provider Demographics
NPI:1033304092
Name:KOESTNER, DANIELLE KAY-TANIS (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:KAY-TANIS
Last Name:KOESTNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ALTAIR PKWY STE 3100
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7653
Mailing Address - Country:US
Mailing Address - Phone:614-360-9995
Mailing Address - Fax:614-745-0165
Practice Address - Street 1:400 ALTAIR PKWY
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7652
Practice Address - Country:US
Practice Address - Phone:614-360-9995
Practice Address - Fax:614-745-0165
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231858Medicare Oscar/Certification