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General NPI Number Information
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NPI Number | 1437108008
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Entity Type | Individual
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Provider Name | ANN M KOOIKER MD
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Gender | Female
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 16201 90TH ST NE SUITE 200
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City | OTSEGO
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State | MN
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Zip | 55330-7463
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Country | US
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Telephone | 763-746-9492
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Fax | 763-746-3685
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Provider Business Mailing Address
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Address Line | 1900 SILVER LAKE RD NW SUITE 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1786
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Country | US
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Telephone | 651-628-9566
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Fax | 651-628-0411
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 30772
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License Number State | MN
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