Provider Demographics
NPI:1083651715
Name:KOIVUNEN, DEBRA GAIL (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:GAIL
Last Name:KOIVUNEN
Suffix:
Gender:F
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-8454
Practice Address - Fax:573-884-6054
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9810208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102524OtherHEALTHLINK
MO12134OtherBLUESHIELD/BLUE CHOICE
MO20021544OtherRR MEDICARE
MO1704022OtherUNITED HEALTHCARE
KS2086347601OtherKANSAS MEDICAID
MO202616306Medicaid
MO202616306Medicaid
KS2086347601OtherKANSAS MEDICAID
MO1704022OtherUNITED HEALTHCARE
MO013011108Medicare PIN