Provider Demographics
NPI:1861997397
Name:KOESTNER, DANIEL S (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:KOESTNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 836 BOX 515
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09636-0009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95121 VILLAGGIO DEGLI ULIVI
Practice Address - Street 2:
Practice Address - City:SIGONELLA
Practice Address - State:CATANIA
Practice Address - Zip Code:95121
Practice Address - Country:IT
Practice Address - Phone:314-624-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0102205782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program