Individual provider · Type 1 NPI

Corey John Koll, PA-C

Surgical Physician Assistant · Grand Rapids, MI

NPI number 1649787128 Active

Practice location

1111 Leffingwell Ave NE
Grand Rapids, MI 49525-6406

Fax (616) 464-6170

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X5601008527 (MI)

Surgical Physician Assistant: Definition to come...

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About NPI 1649787128

Corey John Koll, PA-C's National Provider Identifier is 1649787128, issued on Jan 5, 2018. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Grand Rapids, MI. The record was last updated on Jan 5, 2018.