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Mikaela J Koller

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

10625 W North Ave Ste 101b, Wauwatosa, WI 53226-2315

PECOS Enrollment

This provider is enrolled in PECOS as MIKAELA KOLLER.

Based on the most recent information from CMS, provider Mikaela J Koller is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1952156010
Provider Type
Individual
Full Name
Koller, Mikaela J
Gender
Female

Sole Proprietor
No
Enumeration Date
4/22/2024
Last Updated
8/15/2025

Contact Information

Practice Location

10625 W North Ave Ste 101b, Wauwatosa, WI 53226-2315

(414) 877-5350

Unlisted Fax

Mailing Location

28863 Oregon Rd Apt C29, Perrysburg, OH 43551-3557

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License Unlisted Issuer

Mikaela J Koller

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Bell, Nathan P.

Fell, Ryan S

Davis, Ellen

Schiller, Dean O

Butts, Caroline Wheeler

Vignali, Sydney Avalon

Riesch, Judith M

Kilroe, Megan Colleen

Patzlsberger, Antoinette Marie

Gustavson, Kristin Margaret