Provider Demographics
NPI:1821093535
Name:KOEHLER, MATTHEW P (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:KOEHLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7225 OLD OAK BLVD
Mailing Address - Street 2:#B303
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130
Mailing Address - Country:US
Mailing Address - Phone:440-243-7400
Mailing Address - Fax:440-243-9034
Practice Address - Street 1:28501 ORCHARD LAKE RD
Practice Address - Street 2:120
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2951
Practice Address - Country:US
Practice Address - Phone:248-553-9800
Practice Address - Fax:248-553-9808
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2013-10-02
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Provider Licenses
StateLicense IDTaxonomies
OH049666207W00000X
MI4301102751207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0931159OtherBCBSM
MI1821093535Medicaid
OH000000512381OtherANTHEM
MI1821093535Medicaid