Provider Demographics
NPI:1740250471
Name:KOELLA, LOUIS E (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:E
Last Name:KOELLA
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 700
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-0700
Mailing Address - Country:US
Mailing Address - Phone:931-598-5648
Mailing Address - Fax:931-598-9984
Practice Address - Street 1:1314 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2303
Practice Address - Country:US
Practice Address - Phone:931-598-5648
Practice Address - Fax:931-598-9984
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1922160100OtherGROUP NPI
3709730Medicare ID - Type UnspecifiedMEDICARE GROUP
H32927Medicare UPIN
3862100Medicare ID - Type Unspecified