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NPI Code Detail

MEDICARE: MICHAEL COOPER D.O.

MEDICARE: MICHAEL COOPER D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician12946OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336109727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL COOPER D.O.
Provider Business Mailing Address
First Line : 1515 N HARVARD AVE
Second Line : SUITE E
City : TULSA
State : OK
Zip : 74115-4957
Country : US
Telephone Number : 918-832-6049
Fax Number : 918-832-6055
Provider Business Practice Location Address
First Line : 3100 MEDICAL PKWY
Second Line : 100
City : CLAREMORE
State : OK
Zip : 74017-1088
Country : US
Telephone Number : 918-341-1000
Fax Number : 918-293-3141
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2006
Last Update Date : 02/17/2011

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Directions to “ MICHAEL COOPER D.O.” Practice Location

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