Van Kooten, Mary
Van Kooten, Mary is an individual health care provider with primary practice located at 550 S Landmark Ave , Bloomington IN 47403-3239. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Adult Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Van Kooten, Mary can be contacted via phone (812) 355-6900.Contact Information
Primary practice address
550 S Landmark Ave
Bloomington IN 47403-3239
Phone: (812) 355-6900
Fax: (812) 333-5978
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Adult Medicine | 207QA0505X | 01057928A | Indiana |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 01057928A | Indiana |
Profile Details
| NPI number | 1619972601 |
|---|---|
| LBN Legal business name | Van Kooten, Mary |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 16th, 2005 |
| Last updated | Sep 9th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619972601 | NPPES |
| Indiana | Other | 090540396 | MEDICARE PTAN |
| Indiana | Other | Q00228730 | MEDICARE PTAN |
| Indiana | MEDICAID | 200452880 | MEDICARE PTAN |
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