Provider Demographics
NPI:1669525739
Name:KAEHLER, MARK R (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:KAEHLER
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 1116
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-1116
Mailing Address - Country:US
Mailing Address - Phone:425-793-1995
Mailing Address - Fax:
Practice Address - Street 1:176 1ST AVE N
Practice Address - Street 2:OCEAN BEACH HOSPITAL - EMCARE EMERGENCY PHYSICIANS
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624-9137
Practice Address - Country:US
Practice Address - Phone:360-642-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026390207P00000X
CAG56629207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E92736Medicare UPIN