Individual
MR. JONATHAN MICHAEL KOOIMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 GROVE RD FL 5, GREENVILLE, SC 29605-4210
(864) 455-4411
(864) 455-4480
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD87590
SC
208000000X
Pediatrics Physician
MD87590
SC
208M00000X
Hospitalist Physician
Primary
MD87590
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
SC
Enumeration date
01/11/2018
Last updated
09/06/2022
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