Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO 3281 | FL |
N | 222Z00000X | Podiatrist | PO 3281 | FL |
N | 213EP1101X | Primary Podiatric Medicine | PO 3281 | FL |
N | 111NR0200X | Radiology | PO 3281 | FL |
N | 213ER0200X | Radiology | PO 3281 | FL |
N | 2081S0010X | Sports Medicine | PO 3281 | FL |
N | 213ES0000X | Sports Medicine | PO 3281 | FL |
Y | 213ES0103X | Foot & Ankle Surgery | PO 3281 | FL |
N | 213ES0131X | Foot Surgery | PO 3281 | FL |
NPI | 1578629770 |
---|---|
Provider Name | Dr. Michelle Koo |
First Address | Miami Beach, FL 33139-2421 |
Second Address | Miami Beach, FL 33140-2818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 28/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340656300 | (05) | FL |