Provider Demographics
NPI:1205924321
Name:KOEHLER, JILL E (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:E
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4201 ST. ANTIONE UHC 5D
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-5051
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN
Practice Address - Street 2:CHILDREN'S HOSPITAL OF MI
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-0113
Practice Address - Fax:313-993-7166
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051696207PP0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B51090OtherBLUE SHIELD
MI2787690Medicaid
MIE82633Medicare UPIN
MIC37626066Medicare PIN