Provider Demographics
NPI:1568492114
Name:KOEHN, NORMAN S (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:S
Last Name:KOEHN
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:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:3311 E MURDOCK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3054
Practice Address - Country:US
Practice Address - Phone:316-689-9171
Practice Address - Fax:316-689-9905
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS018204OtherBCBS
KS16850OtherCOVENTRY
KS497OtherPHS
KS12149467OtherMULTIPLAN
KS100108OtherHPK
KS018204Medicare ID - Type Unspecified
KS497OtherPHS