Basic Information
| Provider Information | |||||||||
| NPI: | 1053548933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOOIKER | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | ARTHUR | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1227 E RUSHOLME ST | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528032459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634211000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2450 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126726000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2009 | ||||||||
| LastUpdateDate: | 06/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | DO-4437 | IA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 63384 | MN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.