Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME109089 | FL |
N | 207ND0900X | Dermatopathologist | 4301086274 | MI |
N | 207NS0135X | Procedural Dermatology | 4301086274 | MI |
NPI | 1427269885 |
---|---|
Provider Name | Dr. Kaisa M. Vanderkooi |
First Address | Tallahassee, FL 32317-3859 |
Second Address | Tallahassee, FL 32308-5317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 02/09/2015 |