Provider Demographics
NPI:1447266796
Name:KOIS, JEAN MARIE (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:KOIS
Suffix:
Gender:F
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5070
Mailing Address - Fax:704-316-5075
Practice Address - Street 1:9604 HOLLY POINT DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4913
Practice Address - Country:US
Practice Address - Phone:704-316-5070
Practice Address - Fax:704-316-5075
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401086207N00000X
SC26801207N00000X
GA40129207N00000X
PAMD-045779-L207N00000X
AL16461207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904489Medicaid
SCN0108AMedicaid
F38996Medicare UPIN
NC2055268Medicare ID - Type Unspecified