Koeppen, Michael

Koeppen, Michael is an individual health care provider with primary practice located at 221 Ne Glen Oak Ave , Peoria IL 61603-4307. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Koeppen, Michael can be contacted via phone (309) 672-5522.

Contact Information

Primary practice address
221 Ne Glen Oak Ave Peoria IL 61603-4307
Phone: (309) 672-5522
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036064957 Illinois

Profile Details

NPI number 1679535728
LBN Legal business name Koeppen, Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 4th, 2006
Last updated Feb 5th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679535728 NPPES
Illinois MEDICAID 036064957
Illinois Other 36064957
Illinois Other P00195431

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