MEDICARE: DR. MICHELLE KOO DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO 3281	FL
2	213EP1101X	Primary Podiatric Medicine Podiatrist	PO 3281	FL
3	213ER0200X	Radiology Podiatrist	PO 3281	FL
4	213ES0000X	Sports Medicine Podiatrist	PO 3281	FL
5	213ES0000X	Sports Medicine Podiatrist	2002	NV
6	213ES0103X	Foot & Ankle Surgery Podiatrist	PO 3281	FL
7	213ES0131X	Foot Surgery Podiatrist	PO 3281	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578629770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE KOO DPM

Provider Business Mailing Address
First Line	:	1602 ALTON RD # 480
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-2421
Country	:	US
Telephone Number	:	954-649-8580
Fax Number	:

Provider Business Practice Location Address
First Line	:	4302 ALTON RD STE 300
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2818
Country	:	US
Telephone Number	:	305-672-9989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	06/09/2025

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Directions to “ DR. MICHELLE KOO DPM” Practice Location

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