MEDICARE: DR. KIRSTEN MARIE KOOS M.D., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	44221	MN

General Provider Information

NPI Number	:	1508048133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRSTEN MARIE KOOS M.D., M.P.H.

Provider Business Mailing Address
First Line	:	12515 ROYAL POINT CT NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-7708
Country	:	US
Telephone Number	:	612-310-4768
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 NORMANDALE LAKE BLVD
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55437-3813
Country	:	US
Telephone Number	:	952-893-0403
Fax Number	:	952-893-3700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	09/19/2012

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