Provider Demographics
NPI:1508048133
Name:KOOS, KIRSTEN MARIE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:MARIE
Last Name:KOOS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:KIRSTEN
Other - Middle Name:MARIE
Other - Last Name:MCGRAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12515 ROYAL POINT CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7708
Mailing Address - Country:US
Mailing Address - Phone:612-310-4768
Mailing Address - Fax:
Practice Address - Street 1:8500 NORMANDALE LAKE BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-3813
Practice Address - Country:US
Practice Address - Phone:952-893-0403
Practice Address - Fax:952-893-3700
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN442212083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine