Michael William Koehne, DDS
Individual provider Active NPI General Practice Dentistry · Wheaton, IL
NPI 1699798496 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1699798496
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 319 E Roosevelt Rd
Wheaton, IL 60187-5526 - Phone
- (630) 665-5555
- Fax
- (630) 665-5510
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150312000404 | IL | Order and Referring Only - Dentist |
0547586414 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019019448 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amber Dental PC | Current |
Accepting new patients |
Locations
319 E Roosevelt Rd
Wheaton, IL 60187
Phone (630) 665-5555
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
319 E Roosevelt Rd
Wheaton, IL 60187-5526
Mailing address
319 E Roosevelt Rd
Wheaton, IL 60187-5526
Phone (630) 665-5555
Other providers in Wheaton, IL
- Roberta Knox
- Tracy Ko
- Michelle Kocher
- Jessica Elizabeth Kocum
- Michal Kocum
- Christopher James Koeller
- Elizabeth Kohler-Rausch
- Amy Kohlmann
- Scott J Kolbaba
- Tara Kolmodin
All providers in Wheaton, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.