Provider Demographics
NPI:1245483908
Name:KOEBLER, ANTHONY R
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:R
Last Name:KOEBLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 N RANDALL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2306
Mailing Address - Country:US
Mailing Address - Phone:847-888-0750
Mailing Address - Fax:847-888-2152
Practice Address - Street 1:1435 N RANDALL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2306
Practice Address - Country:US
Practice Address - Phone:847-888-0750
Practice Address - Fax:847-888-2152
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL057551OtherNATIONAL CERTIFICATION