Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301096403 | MI |
N | 2080P0204X | Pediatric Emergency Doctor | DR.0053959 | CO |
NPI | 1023339249 |
---|---|
Provider Name | Dr. Erica Vanderkooy |
First Address | Kalamazoo, MI 49008-1282 |
Second Address | Kalamazoo, MI 49008-1282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 07/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04925378 | (05) | CO |