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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619972601 NPPES
Indiana Other 090540396 MEDICARE PTAN
Indiana Other Q00228730 MEDICARE PTAN
Indiana MEDICAID 200452880 MEDICARE PTAN

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