Provider Demographics
NPI:1437108008
Name:KOOIKER, ANN M (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:KOOIKER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:16201 90TH ST NE
Practice Address - Street 2:SUITE 200
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-7463
Practice Address - Country:US
Practice Address - Phone:763-746-9492
Practice Address - Fax:763-746-3685
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-09-24
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Provider Licenses
StateLicense IDTaxonomies
MN307722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN645285000Medicaid
MN645285000Medicaid
MN260002628Medicare Oscar/Certification