Provider Demographics
NPI:1669544623
Name:KOEHNEN, THOMAS CHARLES (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHARLES
Last Name:KOEHNEN
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 1:38818 730TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081-4482
Mailing Address - Country:US
Mailing Address - Phone:507-375-7321
Mailing Address - Fax:
Practice Address - Street 1:38818 730TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-4482
Practice Address - Country:US
Practice Address - Phone:507-375-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25673207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services