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Individual
JON B KOOISTRA
Active
Individual
JON B KOOISTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
18484-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1175
DEAN HEALTH INSURANCE
WI
05
—
31012500
—
WI
Enumeration date
05/09/2006
Last updated
05/19/2014
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