Healthcare Provider Details

I. General information

NPI: 1811215312
Provider Name (Legal Business Name): TOSKHAN JAMAAL MARCEL COOPER-SHELTON M.D., M.B.A., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 S 9TH ST
ESCANABA MI
49829-3623
US

IV. Provider business mailing address

618 S 9TH ST
ESCANABA MI
49829-3623
US

V. Phone/Fax

Practice location:
  • Phone: 906-318-9405
  • Fax:
Mailing address:
  • Phone: 906-318-9405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301509672
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD450412
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01072862A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: