Provider Demographics
NPI:1134299282
Name:ISABEL H KOELSCH MD
Entity Type:Organization
Organization Name:ISABEL H KOELSCH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:KOELSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-776-1500
Mailing Address - Street 1:1850 W MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-776-1500
Mailing Address - Fax:303-772-2995
Practice Address - Street 1:1850 W MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:303-776-1500
Practice Address - Fax:303-772-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23406207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01234061Medicaid
50101Medicare ID - Type Unspecified
CO01234061Medicaid