Provider Demographics
NPI:1407848013
Name:KOEPSEL, KIRK ALLEN (DPM)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:ALLEN
Last Name:KOEPSEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 BAY AREA BLVD
Mailing Address - Street 2:STE G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2538
Mailing Address - Country:US
Mailing Address - Phone:281-488-3237
Mailing Address - Fax:281-488-4218
Practice Address - Street 1:1234 BAY AREA BLVD
Practice Address - Street 2:STE G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2538
Practice Address - Country:US
Practice Address - Phone:281-488-3237
Practice Address - Fax:281-488-4218
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX946213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112232701Medicaid
TX112232701Medicaid
T14242Medicare UPIN