Provider Demographics
NPI:1497798185
Name:KOEWLER, JOAN M (DPM PA)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:KOEWLER
Suffix:
Gender:F
Credentials:DPM PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2403
Mailing Address - Country:US
Mailing Address - Phone:941-923-4999
Mailing Address - Fax:941-923-4998
Practice Address - Street 1:4157 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2403
Practice Address - Country:US
Practice Address - Phone:941-923-4999
Practice Address - Fax:941-923-4998
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1696213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87902OtherBCBS
FL480027804OtherRAIL ROAD MEDICARE
FL87902Medicare PIN
FLT55595Medicare UPIN
FL87902ZMedicare PIN