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General NPI Number Information
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NPI Number | 1366716243
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Entity Type | Organization
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Legal Business Name | MICHELLE KOO, D.P.M., P.A.
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 1602 ALTON RD # 480
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City | MIAMI BEACH
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State | FL
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Zip | 33139-2421
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Country | US
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Telephone | 786-459-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 1602 ALTON RD # 480
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City | MIAMI BEACH
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State | FL
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Zip | 33139-2421
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHELLE KOO
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Credential | DPM
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Telephone | 954-770-0587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3281
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License Number State | FL
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