Healthcare Provider Details

I. General information

NPI: 1689061194
Provider Name (Legal Business Name): KOOS EDZO HOVINGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MIDDENWEG 104
AMSTERDAM NOORD-HOLLAND
1097BT
NL

IV. Provider business mailing address

MIDDENWEG 104
AMSTERDAM NOORD-HOLLAND
1097BT
NL

V. Phone/Fax

Practice location:
  • Phone: 0031641163337
  • Fax:
Mailing address:
  • Phone: 0031641163337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number19066745801
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: