Healthcare Provider Details

I. General information

NPI: 1982345955
Provider Name (Legal Business Name): JOSEPH COOPER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 INKSTER RD
GARDEN CITY MI
48135-4001
US

IV. Provider business mailing address

212 BOB WHITE LN
QUICKSBURG VA
22847-1437
US

V. Phone/Fax

Practice location:
  • Phone: 734-458-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101028773
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: