Provider Demographics
NPI:1427001635
Name:KOELZ, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:KOELZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 NICOLLET AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2420
Mailing Address - Country:US
Mailing Address - Phone:612-573-2232
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2420
Practice Address - Country:US
Practice Address - Phone:612-573-2232
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1942557Medicaid
MNHP13715OtherHEALTHPARTNERS
MN714985000Medicaid
MN100700OtherUCARE
WI30627000Medicaid
MN9214136OtherDAKOTA CARE
MN08829KOOtherBLUE CROSS
MN297G1KOOtherBLUE CROSS
MN300077289OtherRAILROAD MEDICARE MN
MN0247009OtherPREFERRED ONE
MN22845OtherAMERICA'S PPO
MNA96024Medicare UPIN
MN300077289OtherRAILROAD MEDICARE MN
MN0247009OtherPREFERRED ONE
MN08829KOOtherBLUE CROSS
MN714985000Medicaid
IA1942557Medicaid