Individual
KENYN L. KOOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
849 KELLOGG AVE, JANESVILLE, WI 53546-2808
(608) 755-7960
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
86593
SC
390200000X
Student in an Organized Health Care Education/Training Program
7185-851
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
SC
Enumeration date
08/08/2018
Last updated
09/23/2021
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