Healthcare Provider Details

I. General information

NPI: 1447266796
Provider Name (Legal Business Name): JEAN MARIE KOIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9604 HOLLY POINT DR
HUNTERSVILLE NC
28078-4913
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-5070
  • Fax: 704-316-5075
Mailing address:
  • Phone: 704-316-5070
  • Fax: 704-316-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number200401086
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number26801
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number40129
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD-045779-L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number16461
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: