MEDICARE: DR. CHRISTOPHER COOLEY 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
1	207P00000X	Emergency Medicine Physician	5101020869	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1437577673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER COOLEY D.O

Provider Business Mailing Address
First Line	:	177 N GEORGETOWN SQ
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-3260
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 INDIAN MOUND W
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-2261
Country	:	US
Telephone Number	:	248-396-2212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2014
Last Update Date	:	08/15/2016

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