Active NPI
Arlyn A Koeller, MD
- Family Medicine Physician
- Iron River, WI
National Provider Identifier
1215987755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 14308
- Practice address
- 7665 US Highway 2
The Lakes Community Health Center
Iron River, WI 54847-4690 - Phone
- (715) 372-5001
- Fax
- (715) 372-5067
- NPI assigned
- May 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 14308 | WI | Primary |
Addresses
Primary practice location
7665 US Highway 2
The Lakes Community Health Center
Iron River, WI 54847-4690
Mailing address
7665 US Highway 2
Iron River, WI 54847-4690
Phone (715) 372-5001
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30972300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14308 | WI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317772800000",
"number": "1215987755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7665 US HIGHWAY 2",
"city": "IRON RIVER",
"state": "WI",
"postal_code": "548474690",
"telephone_number": "715-372-5001",
"fax_number": "715-372-5067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7665 US HIGHWAY 2",
"address_2": "THE LAKES COMMUNITY HEALTH CENTER",
"city": "IRON RIVER",
"state": "WI",
"postal_code": "548474690",
"telephone_number": "715-372-5001",
"fax_number": "715-372-5067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOELLER",
"first_name": "ARLYN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-12",
"last_updated": "2011-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "14308",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30972300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Iron River, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.