Individual
DR. MICHAEL J VANDER KOOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
480 E DIVISION ST, FOND DU LAC, WI 54935-3734
(920) 926-4100
(920) 926-4190
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
37647
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32451900
—
WI
Enumeration date
04/05/2006
Last updated
10/21/2020
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