Provider Demographics
NPI:1518147024
Name:HAROLD M. KOEHLER DPM, PC
Entity Type:Organization
Organization Name:HAROLD M. KOEHLER DPM, PC
Other - Org Name:UNIVERSITY FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-377-0033
Mailing Address - Street 1:2251 N SQUIRREL RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-4600
Mailing Address - Country:US
Mailing Address - Phone:248-377-0033
Mailing Address - Fax:248-377-0035
Practice Address - Street 1:2251 N SQUIRREL RD
Practice Address - Street 2:STE. 100
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-4600
Practice Address - Country:US
Practice Address - Phone:248-377-0033
Practice Address - Fax:248-377-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHK400090213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F34139OtherBLUE CROSS
MIDN8013OtherRAILROAD MEDICARE
MI2749949Medicaid
MI5635473OtherBLUE CROSS
MI0F34139OtherBLUE CARE NETWORK ADVANTAGE/BCN
MI5635473OtherBLUE CROSS
MI=========OtherCOMMERCIAL
MI4792970001Medicare NSC
MI5635473Medicare PIN
MI5635473OtherBLUE CROSS