Provider Demographics
NPI:1033505516
Name:KOEBELE, CHRIS ROMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:ROMAN
Last Name:KOEBELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16605 CHESTNUT GLEN PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-6121
Mailing Address - Country:US
Mailing Address - Phone:502-709-0430
Mailing Address - Fax:
Practice Address - Street 1:16605 CHESTNUT GLEN PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-6121
Practice Address - Country:US
Practice Address - Phone:502-709-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine