Ksenia Koltun, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

4301503468 Issued in MI

Practice address

44201 Dequindre Rd
Troy, MI 48085-1117

Phone

(248) 964-5000

NPI assigned

Jun 11, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Miss Ksenia Koltun Stark Former name

Medicare fee-for-service enrollment

Enrolled in OK, MI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Anesthesiology

Education

Other, 2011

Medicare assignment

May accept Medicare assignment

Group practices

Medical Directors Consultants PLCGroup PAC ID 9739697822, 17 clinicians

Northstar Anesthesia of Michigan III PLLCGroup PAC ID 7911325469, 561 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medical Directors Consultants PLC

  • Anesthesiology Physician
  • Bloomfield Hills, MI
  • NPI 1245121177
  Medicare reassignment Care Compare group NPD
• Northstar Anesthesia of Michigan III PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Irving, TX
  • NPI 1972126209

  MI

  Medicare reassignment Care Compare group NPD
• Affiliated Anesthesiologists, LLC

  • Anesthesiology Physician
  • Oklahoma City, OK
  • NPI 1710214267
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• William Beaumont Hospital

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679097600000",
    "number": "1609161231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3810 CARRIAGE RD",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483011900",
            "telephone_number": "847-208-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44201 DEQUINDRE RD",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480851117",
            "telephone_number": "248-964-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLTUN",
        "first_name": "KSENIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-11",
        "last_updated": "2023-03-18",
        "certification_date": "2023-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OK",
            "license": "31106",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301098662",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301503468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KSENIA",
            "last_name": "STARK",
            "middle_name": "KOLTUN",
            "prefix": "MISS",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lori Kola, LLP
• Karl F Kolbe, MD
• Myra Gail Kolin, MD
• Mark Kolins
• Yael Duer Koloff, DO
• Alexa Komic
• Stephanie Kon, PA
• Marie Konczalski, MD
• Mark P Koniuch, MD
• Gabrielle Marie Konstan, MD

• Anesthesiology Physician in Troy, MI
• Providers in Troy, MI by specialty
• Anesthesiology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.