Provider Demographics
NPI:1093750283
Name:KOOIMA, RICKY (MD)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:KOOIMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0900
Mailing Address - Country:US
Mailing Address - Phone:605-504-5400
Mailing Address - Fax:605-504-5150
Practice Address - Street 1:1200 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0900
Practice Address - Country:US
Practice Address - Phone:605-336-2140
Practice Address - Fax:605-336-1677
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4499208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6700252Medicaid
SD6700252Medicaid