Provider Demographics
NPI:1932212461
Name:COE, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:COE
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 1:1515 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1618
Mailing Address - Country:US
Mailing Address - Phone:920-623-2200
Mailing Address - Fax:
Practice Address - Street 1:118 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-2104
Practice Address - Country:US
Practice Address - Phone:920-356-1000
Practice Address - Fax:920-356-0719
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36330174400000X
WI36330-20207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003837OtherPHYSICIANS PLUS
WI32123200Medicaid
WI61268OtherDEAN HEALTH SYSTEMS
WI1700361940OtherGEHA
WI11801OtherDEAN
WI391796912OtherWPS
WIGO6025Medicare UPIN
WI1237790001Medicare NSC
WIWI1856Medicare PIN
WI32123200Medicaid
WIWI1856001Medicare PIN
WI1003837OtherPHYSICIANS PLUS
WI1700361940OtherGEHA
WI000116220Medicare PIN
WI11801OtherDEAN