Individual
CAROL A KOOISTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
541 FLOYD RD, SPARTANBURG, SC 29307-1520
(864) 585-6179
(864) 583-5403
Mailing address
541 FLOYD RD, 541 FLOYD ROAD, SPARTANBURG, SC 29307-1520
(864) 585-6179
(864) 583-5403
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
13349
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
135C9
BCBS
—
05
—
89135C9
—
NC
01
—
B91448
UPIN
NC
01
—
P00316714
MEDICARE RR
NC
Enumeration date
12/19/2005
Last updated
02/13/2011
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