Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 0054116 | CO |
N | 2080P0205X | Pediatric Endocrinologist | 35089950 | OH |
N | 2080P0205X | Pediatric Endocrinologist | 57.004470 | OH |
NPI | 1487866786 |
---|---|
Provider Name | Dr. Michaela Koontz |
First Address | Highlands Ranch, CO 80126-5626 |
Second Address | Highlands Ranch, CO 80126-5626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 28/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000225223 | UNISON (01) | OH |
000000538734 | ANTHEM (01) | OH |
1021184600001 | PA MEDICAID (01) | PA |
2770961 | (05) | OH |
421800 | WELLCARE (01) | OH |
751167 | BUCKEYE (01) | OH |
9199095 | AETNA (01) | OH |