IndividualActive
Corey Koll, PA-C
NPI 1649787128 · Surgical Physician Assistant · Grand Rapids, MI
Provider details
- NPI number
- 1649787128
- Entity type
- Individual
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- License
- 5601008527 (MI)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
1111 Leffingwell Ave Ne
Grand Rapids, MI 49525-6406
Phone: (616) 459-7101
Fax: (616) 464-6170
Approximate (ZIP-level) locationGet directions
Mailing address
1111 Leffingwell Ave Ne
Grand Rapids, MI 49525-6406
Registry dates
- Enumerated
- 2018-01-05
- Last updated
- 2018-01-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.