Provider Demographics
NPI:1245398932
Name:KOEHLER, IRMGARD KILB (MD)
Entity Type:Individual
Prefix:DR
First Name:IRMGARD
Middle Name:KILB
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:IRMGARD
Other - Middle Name:KILB
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:#1301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-578-0081
Mailing Address - Fax:312-578-0270
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:#1301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-578-0081
Practice Address - Fax:312-578-0270
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-048744207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology