Individual
DR. SU MIN KO
Active
Individual
DR. SU MIN KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
2009001606
MO
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
0101250991
VA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
2009001606
MO
208VP0014X
Interventional Pain Medicine Physician
Primary
0101250991
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000640716
BCBS
MO
05
—
1336375450
—
MO
01
—
2009001606
MEDICAL LICENSE
MO
01
—
9496409
AETNA
MO
01
—
98246
HCUSA
MO
Enumeration date
06/03/2009
Last updated
02/20/2017
Update your record
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