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General NPI Number Information
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NPI Number | 1427269885
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Entity Type | Individual
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Provider Name | KAISA M. VANDERKOOI M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 2181 ORANGE AVE E
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City | TALLAHASSEE
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State | FL
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Zip | 32311-6144
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Country | US
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Telephone | 734-306-2299
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Fax |
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Provider Business Mailing Address
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Address Line | 2181 ORANGE AVE E
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City | TALLAHASSEE
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State | FL
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Zip | 32311-6144
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Country | US
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Telephone | 734-306-2299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 4301086274
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 4301086274
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME109089
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License Number State | FL
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