Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 102697 | MO |
NPI | 1326156142 |
---|---|
Provider Name | Michele Koo |
First Address | St. Louis, MO 63122 |
Second Address | Saint Louis, MO 63122-6161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F58336 | (02) | MO |