Provider Demographics
NPI:1235194143
Name:KOITHAN, THOMAS KIRBY (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KIRBY
Last Name:KOITHAN
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 1:495 S. 51ST ST.
Mailing Address - Street 2:UNIT #40
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-6984
Mailing Address - Country:US
Mailing Address - Phone:515-457-8931
Mailing Address - Fax:
Practice Address - Street 1:2500 82 PL
Practice Address - Street 2:WADLE AND ASSOCIATES PC
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-4329
Practice Address - Country:US
Practice Address - Phone:515-270-1344
Practice Address - Fax:515-270-6515
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIOWA27992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0106294Medicaid
I4144Medicare ID - Type Unspecified
IA0106294Medicaid