Provider Demographics
NPI:1063487924
Name:KOERNER, REBECCA M (MD)
Entity Type:Individual
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First Name:REBECCA
Middle Name:M
Last Name:KOERNER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5790
Mailing Address - Fax:652-883-5395
Practice Address - Street 1:401 PHALEN BOULEVARD
Practice Address - Street 2:MAIL STOP 41104E
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7760
Practice Address - Fax:651-254-7765
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-10-03
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Provider Licenses
StateLicense IDTaxonomies
MN26410208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN225003900Medicaid
MN225003900Medicaid
250000355Medicare ID - Type Unspecified