Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 4301051696 | MI |
Y | 208000000X | Pediatrician | 4301051696 | MI |
NPI | 1205924321 |
---|---|
Provider Name | Dr. Jill E. Koehler |
First Address | Detroit, MI 48201 |
Second Address | Detroit, MI 48201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 10/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0B51090 | BLUE SHIELD (01) | MI |
2787690 | (05) | MI |
E82633 | (02) | MI |