Provider Demographics
NPI:1649464652
Name:KOEHLER, DELANEY (MD)
Entity type:Individual
Prefix:
First Name:DELANEY
Middle Name:
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:STE 570
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9606
Mailing Address - Country:US
Mailing Address - Phone:815-463-3700
Mailing Address - Fax:815-463-3701
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9508
Practice Address - Country:US
Practice Address - Phone:815-463-3700
Practice Address - Fax:815-463-3701
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine