Provider Demographics
NPI:1164837977
Name:KOEHN, ZACHARY A (DO)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:A
Last Name:KOEHN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3379 CHILI AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5325
Mailing Address - Country:US
Mailing Address - Phone:585-889-0750
Mailing Address - Fax:585-889-0759
Practice Address - Street 1:3379 CHILI AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624
Practice Address - Country:US
Practice Address - Phone:585-889-0750
Practice Address - Fax:585-889-0759
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294277207Q00000X
MI5101021435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine