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NPI Code Detail

MEDICARE: DERRICK KANE COOPER MD

MEDICARE: DERRICK KANE COOPER MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1881532083
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK KANE COOPER MD
Provider Business Mailing Address
First Line : 3333 BURNET AVENUE
Second Line : MLC 5018
City : CINCINNATI
State : OH
Zip : 45229-3039
Country : US
Telephone Number : 513-636-4315
Fax Number :
Provider Business Practice Location Address
First Line : 3333 BURNET AVENUE
Second Line : MLC 5018
City : CINCINNATI
State : OH
Zip : 45229-3039
Country : US
Telephone Number : 513-636-4315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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